Solicitation No.72062121R00012 - Comprehensive Client-Centered Health Program for Reproductive, Maternal, Newborn, Child and Adolescent Health (C3HP- R.pdf

Issuance Date: July 1, 2021 Deadline for Questions: July 9, 2021, at 1700 East Africa Time Deadline for Receipt of Past Performance Information and Key Personnel Annex: July 26, 2021, at 0700 East Africa Time Deadline for Receipt of Proposal: August 9, 2021, at 0700 East Africa Time

Subject: Request for Proposals (RFP) No. 72062121R00012

Dear Prospective Offerors:

The United States Agency for International Development (USAID) Mission in Tanzania is seeking proposals from responsible organizations interested in implementing the USAID/Tanzania’s Comprehensive Client-Centered Health Program for Reproductive, Maternal, Newborn, Child and Adolescent Health (C3HP- RMNCAH) activity. The proposed activity is to increase the demand for and use of quality integrated RMNCAH services in target regions, particularly women of reproductive age, youth and children, by improving access to quality RMNCAH services in both facilities and the surrounding communities, promoting positive health-seeking behaviors among Tanzania’s population, and enhancing the overall policy environment for RMNCAH service delivery as detailed in Section C of the RFP.

USAID/Tanzania anticipates awarding one Cost-Plus-Fixed-Fee Completion Form contract from this solicitation. The estimated total cost of the contract is between $65,000,000 to $74,000,000, excluding the optional service. The estimated total cost of the optional service is between $3,000,000 to $5,000,000. The anticipated period of performance is five years, subject to availability of funds.

This procurement is being conducted through full and open competition, pursuant to Part 15 of the Federal Acquisition Regulation (FAR). All types of organizations are eligible to compete and to submit offers. All organizations responding to this solicitation, must submit their proposal in accordance with Section L of this RFP. Proposals must be submitted electronically to the USAID Tanzania contracting office mailbox at usaidtzco@usaid.gov. Late proposals will be handled in accordance with FAR Part 52.215-1, Alternate I.

The Request for Proposals (RFP), once issued, and subsequent amendments thereto, can be downloaded from https://beta.sam.gov/.

If substantive questions are received which affect the response to the solicitation, or if changes are made to the closing date and time, as well as other aspects of the RFP, this solicitation will be amended. Any amendments to this solicitation will be issued and posted on the beta.sam.gov mailto:usaidtzco@usaid.gov https://beta.sam.gov/ website. It is the Offeror’s responsibility to check this site periodically for official updates and amendments to the solicitation.

Questions and Answers: The deadline for receiving questions is indicated above. Questions may be submitted to the USAID Tanzania contracting office mailbox at usaidtzco@usaid.gov .

This solicitation in no way obligates USAID to award a contract, nor does it commit USAID to pay any cost incurred in the preparation and submission of the proposal. Furthermore, the Government reserves the right to reject any and all offers, if such action is considered to be in the best interest of the Government.

Thank you for your interest in USAID/Tanzania’s activities.

Best Regards, Ayana Angulo Contracting Officer mailto:usaidtzco@usaid.gov

72062121R00012

SOLICITATION, OFFER AND AWARD

4. TYPE OF SOLICITATION2. CONTRACT NUMBER 3. SOLICITATION NUMBER

7. ISSUED BY CODE 8. ADDRESS OFFER TO (If other than Item 7)

ORDER UNDER DPAS (15 CFR 700)

6. REQUISITION/PURCHASE NUMBER

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

NEGOTIATED (RFP)

SEALED BID (IFB)

5. DATE ISSUED

1. THIS CONTRACT IS A RATED RATING PAGE OF PAGES

1 173

C. E-MAIL ADDRESS

EXT.NUMBERAREA CODE

B. TELEPHONE (NO COLLECT CALLS)A. NAME

10. FOR

INFORMATION

CALL:

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.

(Date)(Hour) local timeuntildepository located in 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

SOLICITATION

9. Sealed offers in original and

PART IV - REPRESENTATIONS AND INSTRUCTIONS

OTHER STATEMENTS OF OFFERORS

EVALUATION FACTORS FOR AWARD

INSTRS., CONDS., AND NOTICES TO OFFERORS

REPRESENTATIONS, CERTIFICATIONS AND

LIST OF ATTACHMENTS

CONTRACT CLAUSES

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

I

J

K

L

M SPECIAL CONTRACT REQUIREMENTS

CONTRACT ADMINISTRATION DATA

DELIVERIES OR PERFORMANCE

INSPECTION AND ACCEPTANCE

PACKAGING AND MARKING

DESCRIPTION/SPECS./WORK STATEMENT

SUPPLIES OR SERVICES AND PRICES/COSTS

SOLICITATION/CONTRACT FORM

PART II - CONTRACT CLAUSESPART I - THE SCHEDULE

H

G

F

E

D

C

B

A

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

11. TABLE OF CONTENTS

18. OFFER DATE17. SIGNATURE

SUCH ADDRESS IN SCHEDULE.

IS DIFFERENT FROM ABOVE - ENTER

15C. CHECK IF REMITTANCE ADDRESS

EXT.NUMBERAREA CODE

15B. TELEPHONE NUMBER

(Type or print)AND

ADDRESS

OF

OFFEROR

CODE FACILITY

16. NAME AND TITLE OF PERSON AUTHORIZED TO SIGN OFFER15A. NAME

DATEAMENDMENT NO.DATEAMENDMENT NO.

and related documents numbered and dated):

amendments to the SOLICITATION for offerors

(The offeror acknowledges receipt of

14. ACKNOWLEDGEMENT OF AMENDMENTS

CALENDAR DAYS (%)30 CALENDAR DAYS (%)20 CALENDAR DAYS (%)10 CALENDAR DAYS (%)

(See Section I, Clause No. 52.232.8)

13. DISCOUNT FOR PROMPT PAYMENT

designated point(s), within the time specified in the schedule.

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

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

OFFER (Must be fully completed by offeror)

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

28. AWARD DATE

(Signature of Contracting Officer)

27. UNITED STATES OF AMERICA

25. PAYMENT WILL BE MADE BY

26. NAME OF CONTRACTING OFFICER (Type or print)

CODE 24. ADMINISTERED BY (If other than Item 7)

ITEM

(4 copies unless otherwise specified)

23. SUBMIT INVOICES TO ADDRESS SHOWN IN

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

22. AUTHORITY FOR USING OTHER THAN FULL AND OPEN COMPETITION:

21. ACCOUNTING AND APPROPRIATION20. AMOUNT19. ACCEPTED AS TO ITEMS NUMBERED

AWARD (To be completed by government)

CODE

REQ-621-21-000022

1400 C

Oddo Linuma olinuma@usaid.gov

PAGE(S)

Ayana Angulo

AUTHORIZED FOR LOCAL REPRODUCTION

Previous edition is unusable

STANDARD FORM 33 (Rev. 9-97)

Prescribed by GSA - FAR (48 CFR) 53.214(c)

12. In compliance with the above, the undersigned agrees, if this offer is accepted within _____0_________ calendar days (60 calendar days unless a different period is inserted

ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

NAME OF OFFEROR OR CONTRACTOR

2 173

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

72062121R00012

(A) (B) (C) (D) (E) (F)

Delivery Location Code: TANZANIA/LOCAL

USAID/Tanzania

686 Old Bagamoyo Road, Msasani

P.O. Box 9130

Dar es Salaam

Tanzania

0001 The purpose of this action is to de-obligate amount of $1,000,000

OPTIONAL FORM 336 (4-86)

Sponsored by GSA

FAR (48 CFR) 53.110

NSN 7540-01-152-8067

ACRONYM LIST

SECTION B – SERVICES/PRICES

B.1 PURPOSE

B.2 CONTRACT TYPE AND SERVICES

B.3 ESTIMATED COST-PLUS-FIXED-FEE AND OBLIGATED AMOUNT

B.3.1 COST PLUS FIXED FEE BUDGET

B.4 REIMBURSEMENT OF COSTS AND PAYMENT OF FIXED FEE

B.5 INDIRECT COSTS

B.6 CEILING ON INDIRECT COSTS

SECTION C – DESCRIPTION/SPECIFICATIONS

SECTION D – PACKAGING AND MARKING

D.1 AIDAR 752.7009 MARKING (JAN 1993)

D.2 BRANDING POLICY

D.3 BRANDING STRATEGY

D.4 BRANDING IMPLEMENTATION PLAN AND MARKING PLAN

SECTION E – INSPECTION AND ACCEPTANCE

E.1 NOTICE LISTING CONTRACT CLAUSES INCORPORATED BY REFERENCE

E.2 INSPECTION AND ACCEPTANCE

SECTION F – DELIVERIES OR PERFORMANCE

F.1 NOTICE LISTING CONTRACT CLAUSES INCORPORATED BY REFERENCE

F.2 PLACE OF PERFORMANCE

F.3 PERIOD OF PERFORMANCE

F.4 REPORTS and DELIVERABLES

SECTION G – CONTRACT ADMINISTRATION DATA

G.1 DOCUMENTATION FOR PAYMENT, AIDAR 752.7003 (NOV 1998)

G.2 CONTRACTING OFFICER’S AUTHORITY

G.3 CONTRACTING OFFICER’S REPRESENTATIVE

G.4 CONTRACTING OFFICE

G.5 PAYING OFFICE

G.6 ACCOUNTING AND APPROPRIATION DATA

G.7 TECHNICAL DIRECTIONS/RELATIONSHIP WITH USAID

SECTION H – SPECIAL CONTRACT REQUIREMENTS

H.1 LANGUAGE REQUIREMENTS

H.2 AUTHORIZED GEOGRAPHIC CODE

H.3 KEY PERSONNEL

H.4 (ADS 302.3.5.19) USAID-FINANCED THIRD-PARTY WEBSITES (NOVEMBER 2017)

RFP No. 72062121R00012 – C3HP RMNCAH

pg. 2

H.5 GOVERNMENT FURNISHED FACILITIES OR PROPERTY

H.6 (AAPD 17-01 – Revision 2) INSURANCE AND SERVICES

H.7 LOGISTICAL SUPPORT

H.8 ENVIRONMENTAL COMPLIANCE

H.9 (ADS 350 maa) FOREIGN GOVERNMENT DELEGATIONS TO INTERNATIONAL

CONFERENCES (JANUARY 2002)

H.10 ELECTRONIC PAYMENTS SYSTEM

H.11 SALARY APPROVALS FOR LONG-TERM AND SHORT-TERM TECHNICAL

ASSISTANCE

H.12 SUBMISSION OF DATASETS TO THE DEVELOPMENT DATA LIBRARY (DDL) (October 2014) 71

H.13 CONSENT TO SUBCONTRACT

H.14 (AAPD-16-02-Rev 2) INFORMATION TECHNOLOGY APPROVAL (DEVIATION NO.

M/OAA-DEV-FAR-20-3c) (APRIL 2020) H.15 (AAPD-16-02-Rev 2) PRIVACY AND SECURITY INFORMATION TECHNOLOGY

SYSTEMS INCIDENT REPORTING (APRIL 2018)

H.16 (AAPD-16-02-Rev 2) SECURITY REQUIREMENTS FOR UNCLASSIFIED INFORMATION

TECHNOLOGY RESOURCES (APRIL 2018)

H.17 AAPD-16-02-Rev2 CLOUD COMPUTING (APRIL 2018)

H.18 ACTIVITY INTEGRATION

H.19 TRAFFICKING IN PERSONS (TIP) NOTIFICATION

H.20 PUBLIC EVENTS AND MEDIA ENGAGEMENT

H.21 VALUE ADDED TAX (VAT) REIMBURSEMENT

H.22 GRANTS UNDER CONTACT

H.23 AIDAR 752.222-70 USAID DISABILITY POLICY (DECEMBER 2004)

H.24 FAR PART 4.21 PROHIBITION ON CONTRACTING FOR CERTAIN COVERED

TELECOMMUNICATIONS AND VIDEO SURVEILLANCE SERVICES OR EQUIPMENT

(SECTION 889) (JANUARY 2021)

H.25 OPTION FOR ADDITIONAL SERVICES – SEPARATELY PRICED

SECTION I – CONTRACT CLAUSES

I.1 FAR 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

I.2 AIDAR 752.252-2 AIDAR CLAUSES INCORPORATED BY REFERENCE (MARCH 2015) .99

I.3 FAR 52.222-35 EQUAL OPPORTUNITY FOR VETERANS (OCTOBER 2015)

I.4 FAR 52.222-36 EQUAL OPPORTUNITY FOR WORKERS WITH DISABILITIES (JULY

2014) 101

I.5 AIDAR 752.222-71 NONDISCRIMINATION (JUNE 2012)

I.6 AIDAR 752.225-70 SOURCE AND NATIONALITY REQUIREMENTS (FEB 2012)

I.7 AIDAR 752.228-7 INSURANCE -- LIABILITY TO THIRD PERSONS (JULY 1997)

I.8 AIDAR 752.229-71 REPORTING OF FOREIGN TAXES (JULY 2007)

pg. 3

I.10 FAR 52.245-1 GOVERNMENT PROPERTY (JAN 2017)

I.11 FAR 52.247-1 -- COMMERCIAL BILL OF LADING NOTATIONS (FEB 2006)

I.12 AIDAR 752.7005 SUBMISSION REQUIREMENTS FOR DEVELOPMENT EXPERIENCE

DOCUMENTS (SEP 2013)

I.13 AIDAR 752.7013 CONTRACTOR-MISSION RELATIONSHIPS [DEVIATION (JUN 2020)]122

I.14 AIDAR 752.7027 PERSONNEL (DEC 1990)

I.15 AIDAR 752.7032 INTERNATIONAL TRAVEL APPROVAL AND NOTIFICATION

REQUIREMENTS (APR 2014)

I.16 AIDAR 752.7034 ACKNOWLEDGEMENT AND DISCLAIMER (DEC 1991)

I.17 (AIDAR 752.7101/AAPD 08-01) VOLUNTARY POPULATION PLANNING ACTIVITIES

(JUN 2008)

SECTION J – LIST OF DOCUMENTS, EXHIBITS AND OTHER ATTACHMENTS

SECTION K – REPRESENTATIONS, CERTIFICATIONS, AND OTHER STATEMENTS OF

OFFERORS

K.1 NOTICE LISTING SOLICITATION PROVISIONS INCORPORATED BY REFERENCE

K.2 FAR 52.204-8 ANNUAL REPRESENTATIONS AND CERTIFICATIONS (MAR 2020)

K.3 FAR 52.204-24 REPRESENTATION REGARDING CERTAIN TELECOMMUNICATIONS

AND VIDEO SURVEILLANCE SERVICES OR EQUIPMENT (OCT 2020)

K. 4 FAR 52.209-7 INFORMATION REGARDING RESPONSIBILITY MATTERS (OCT 2018) .139

K.5 FAR 52.209-12 CERTIFICATION REGARDING TAX MATTERS (OCT 2020)

K.6 FAR 52.209-13 VIOLATION OF ARMS CONTROL TREATIES OR AGREEMENTS-

CERTIFICATION (FEB 2021)

K.7 FAR 52.230-1 COST ACCOUNTING STANDARDS NOTICES AND CERTIFICATION (JUN

2020) 143

K.8 FAR 52.230-7 PROPOSAL DISCLOSURE COST ACCOUNTING PRACTICE CHANGES

(APR 2005)

K.9 SIGNATURE

K.10 AIDAR 752.252-70 PROVISIONS AND CLAUSES TO BE COMPLETED BY THE OFFEROR

(MAR 2015)

SECTION L – INSTRUCTIONS, CONDITIONS, AND NOTICES TO OFFERORS

L.1 FAR 52.252-1 SOLICITATION PROVISIONS INCORPORATED BY REFERENCE (FEB

1998) 147

L.2 FAR 52.215-1 INSTRUCTIONS TO OFFERORS-COMPETITIVE ACQUISITION (JAN 2017)

L.3 FAR 52.216-1 TYPE OF CONTRACT (APR 1984)

L.4 FAR 52.233-2 SERVICE OF PROTEST (SEP 2006)

L.5 FAR 52.252-5 AUTHORIZED DEVIATIONS IN PROVISIONS (NOV 2020)

L.6 WAIVERS UNDER FAR PART 4.2101 PROHIBITION ON COVERED

TELECOMMUNICATIONS AND VIDEO SURVEILLANCE SERVICES AND EQUIPMENT

L.7 GENERAL INSTRUCTIONS TO OFFERORS

pg. 4

L.8 DELIVERY INSTRUCTIONS

L.9 INSTRUCTIONS FOR PREPARATION OF THE TECHNICAL PROPOSAL

L.10 COST PROPOSAL

L.11 SUPPORTING DOCUMENTS

L.12 BRANDING IMPLEMENTATION AND MARKING PLAN

L.13 AWARD WITHOUT DISCUSSIONS

L.14 QUALITY ASSURANCE SURVEILLANCE PLAN (QASP)

SECTION M – EVALUATION FACTORS FOR AWARD

M.1 FAR52.252-1 SOLICITATION PROVISIONS INCORPORATED BY REFERENCE (FEB 1998)

M.2 GENERAL INFORMATION

M.3 TECHNICAL EVALUATION FACTORS

M.4 COST EVALUATION

pg. 5

ACRONYM LIST

ACTs – Artemisinin-based Combination Therapy AYFHS – Adolescent and Youth Friendly Health Services ANC – Antenatal Care ART – Antiretroviral therapy AQL - Acceptable Quality Level C3HP – Comprehensive Client-Centered Health Program CBH & SWP – Community Based Health & Social Welfare Program CECAP – Cervical Cancer Prevention CHS – Community Health Strategy CHW – Community Health Worker CTC – Care and Treatment Centre.

CQI – Continuous Quality Improvement CDCS – Country Development Cooperation Strategy COR – Contract Officer’s Representative DFID – British Department for International Development DR-TB – Drug Resistant Tuberculosis FP – Family Planning GFATM – Global Fund to Fight AIDS, Tuberculosis and Malaria GOT – Government of Tanzania GOZ – Government of Zanzibar GUC - Grants Under Contract HPV - Human Papillomavirus HTI – Health Training Institutions HIV/AIDS - Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome HSSP - Health Sector Strategic Plan iCCM – Integrated Community Case Management IEE – Initial Environmental Examination IMCI – Integrated Management of Childhood Illnesses IPTp – Intermittent Preventive Therapy KMC – Kangaroo Mother Care LEEP – Loop Electrosurgical Excision Procedure mCPR – Modern Contraceptive Prevalence Rate MDR– TB – Multidrug-Resistant Tuberculosis MEL – Monitoring, Evaluation and Learning MNCH – Maternal, Newborn and Child Health MNH – Maternal and Newborn Health MOH – Ministry of Health (Zanzibar) MOHCDGEC – Ministry of Health and Social Welfare, Elderly and Children (Tanzania Mainland) NMNAP - National Multisectoral Nutrition Action Plan NMSF – National Multisectoral Strategic Framework PEPFAR – U.S. President’s Emergency Plan for AIDS Relief PMI – U.S. President’s Malaria Initiative PO-RALG – President’s Office – Regional Administration and Local Government

pg. 6

PPFP - Postpartum Family Planning PWS – Performance Work Statement QoC - Quality of Care RMNCAH – Reproductive, Maternal, Newborn, Child and Adolescent Health SBC – Social Behavior Change SDG – Sustainable Development Goal TB – Tuberculosis TBD – To be Determined TDHS – Tanzania Demographic Health Survey UNAIDS – Joint United Nations Program on HIV/AIDS USG – United States Government VIA – Visual Inspection with Acetic Acid WHO – World Health Organization

SECTION B – SERVICES/PRICES

B.1 PURPOSE

The purpose of this contract is to provide technical assistance services necessary for the successful implementation of the USAID/Tanzania’s Comprehensive Client-Centered Health Program for Reproductive, Maternal, Newborn, Child and Adolescent Health (C3HP- RMNCAH).

B.2 CONTRACT TYPE AND SERVICES

This is a Cost-Plus-Fixed-Fee Completion Form type contract. The contractor must achieve results and meet standards as described under Section C and other requirements of Section F and H in accordance with the performance standards specified herein.

B.3 ESTIMATED COST-PLUS-FIXED-FEE AND OBLIGATED AMOUNT

(a) The total estimated cost-plus-fixed-fee for the performance of this award is [$TBD from Offeror’s cost proposal] (the summaries below represent the budget that will be reflected in the resulting contract. The Contractor shall not be paid any sum in excess of these amounts:

Budget Categories Cost

Total Estimated Cost $

Fixed Fee $

Total Estimated Cost-Plus Fixed Fee $

Total Estimated Contract Cost $

(b)The total estimated cost-plus fixed fee for the performance of the optional service is between $3,000,000.00 and $5,000,000.00

Total Estimated Cost: $

Fixed Fee: $

Total Estimated Cost Plus Fixed Fee: $

(c)The total estimated cost for the performance of the work required hereunder, including the optional service and exclusive of fixed fee, is $[to be inserted by CO at time of award].

(d)Within the estimated cost plus fixed fee specified in paragraphs (a) and (b) above, the amount currently obligated and available for reimbursement of allowable costs incurred by the Contractor for performance hereunder is $[to be inserted by CO at time of award].

B.3.1 COST PLUS FIXED FEE BUDGET

The following budget tables captures the final negotiated cost elements for the performance of the work under the contract and the Optional Service required hereunder.

Final Negotiated budget for the performance of the Contract

Cost Element Amount

Program Implementation $

Subcontracts $

Grants Under Contracts $7,500,000.00

Total Estimated Cost $

Fixed Fee $

Total Estimated Cost-Plus Fixed Fee $

Total Estimated Contract Cost $

Final Negotiated budget Optional Services as described in Section C.III

Cost Element Amount

Program Implementation $

Subcontracts $

Total Estimated Cost $

Fixed Fee $

Total Estimated Cost Plus Fixed Fee $

* Program Implementation will be equal to the sum of all direct costs and indirect costs except for subcontracts. *

B.4 REIMBURSEMENT OF COSTS AND PAYMENT OF FIXED FEE

(a) Allowable costs shall be limited to reasonable, allocable and necessary costs determined in accordance with FAR clause 52.216-7, Allowable Cost and Payment and AIDAR clause 752.7003, Documentation for Payment.

(b) Pursuant to FAR 52.216-8, Fixed Fee, payment of fixed fee shall be allocated based upon the achievement of performance standards outlined in Section C, the approval of required deliverables listed in Section F, the proportion of allowable and allocable costs incurred to achieve the performance standards and complete deliverables.

B.5 INDIRECT COSTS

Prime:

Description Rate Base Type Period

TBD TBD 1/ 1/ 1/

TBD TBD 2/ 2/ 2/

1/ Base of Application: TBD Type of Rate: TBD Period: TBD

2/ Base of Application: TBD Type of Rate: TBD Period: TBD

The Contractor is allowed to recover applicable indirect costs (i.e. overhead, G&A, etc.) on other direct costs (ODCs), if it is part of the Contractor’s usual accounting procedures, consistent with FAR Part 31, and the Negotiated Indirect Cost Rate Agreement (NICRA).

B.6 CEILING ON INDIRECT COSTS

Reimbursements for allowable indirect costs shall be at final negotiated rates but not in excess of the following ceiling rates: [To be completed by Offeror]

Contractor Overhead Rate

Overhead Ceiling Rate %

G&A Rate % G&A Ceiling Rate %

PRIME

MAJOR

SUBCONTRACTOR (S)1

NOTE 1: Insert additional indirect rates as needed for prime and major subcontractors in the above table.

(1) The Government will not be obligated to pay any additional amount should the final

1 “Major subcontractors” are those subcontractors expected to perform at least 20% (as quantified by or calculated by level of effort for staff and/or total estimated direct costs) of the technical effort under the contract being solicited.

Indirect cost exceed the negotiated ceiling rates. If the final indirect cost rates are less than the negotiated ceiling rates, the negotiated rates will be reduced to reflect the lower rates.

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

[END OF SECTION B]

SECTION C – DESCRIPTION/SPECIFICATIONS

Performance Work Statement

I. INTRODUCTION

The purpose of this contract is to implement USAID/Tanzania’s Comprehensive Client-Centered Health Program – Reproductive, Maternal, Newborn, Child and Adolescent Health (C3HP- RMNCAH) activity. Comprehensive Client Centered Health Program (C3HP) is a health care model that is respectful of, and responsive to clients’, families’ and communities’ needs, values, experiences and preferences during the planning, coordination and delivery of health care services.

USAID/Tanzania intends to support the Government of Tanzania’s (GOT) Ministry of Health, Community Development, Gender, Elderly and Children (MOHCDGEC) and the President’s Office-Regional Administration and Local Government (PO-RALG) at the central level and in target Mainland regions as well as the Government of Zanzibar’s (GOZ) Ministry of Health (MOH), their PO-RALG and other local authorities, to deliver high-quality integrated RMNCAH services that will improve health outcomes, particularly for youth and women.

The contract will increase the demand for and use of quality integrated RMNCAH services in target regions, particularly women of reproductive age, youth and children, by improving access to quality RMNCAH services in both facilities and the surrounding communities, promoting positive health-seeking behaviors among Tanzania’s population, and enhancing the overall policy environment for RMNCAH service delivery.

II. ACTIVITY BACKGROUND

1. Global Context

It is estimated that in 2017, 295,000 women around the world died due to complications of pregnancy and childbirth, with major causes including hemorrhage, infection, high blood pressure, unsafe abortion, and obstructed labor. Almost all these deaths occurred in low- and middle-income countries, and almost two thirds in sub-Saharan Africa. Most of these maternal deaths were preventable with appropriate management and care, especially during the preconception, antenatal, labor and delivery periods. Access to basic services such as antenatal care in pregnancy, adequate skilled care during childbirth, and care and support in the first days and weeks after childbirth greatly reduces deaths and influences health outcomes for both mother and child. During the 2012-2017 period, only 59% of births in sub-Saharan Africa were attended by skilled health personnel, while only 52% of pregnant women in sub-Saharan Africa received at least four antenatal visits in 2013-2018.

Maternal health and newborn health are closely linked. While the global under-five mortality rate fell by almost 50% between 2000 and 2017, 5.3 million children still died in 2018 – mainly from preventable causes such as pneumonia, diarrhea and malaria. Almost half of the under-five deaths occurred in the crucial first month of life, with major causes including preterm births, intrapartum-related complications (birth asphyxia or lack of breathing at birth), infections and birth defects.

Preventing unintended pregnancies and reducing adolescent childbearing through universal access to reproductive health care are crucial to the health and well-being of women, children and adolescents. Expanding access to modern contraceptive methods is essential to ensure universal access to reproductive health care. Globally, the proportion of women of reproductive age (15 to 49 years old) who have their need for family planning (FP) satisfied with modern contraceptive methods has continued to increase slowly, from 74 per cent in 2000 to 76 per cent in 2019. However, this is not the same for middle- and low-income countries where there are missed opportunities for education, some societies still practicing taboos and local customs which to a greater extent increases women’s vulnerability including missing the opportunity to access reproductive health services. In sub-Saharan Africa, for instance, the levels of adolescent fertility and teenage pregnancy remain high and there is an observed upward trend of these two indicators that shows this is a growing problem in these countries.

In 2015, the member states of the United Nations came together to update international development goals and craft a call to action to end poverty, protect the planet, and improve the lives and prospects of all people, everywhere. Seventeen Sustainable Development Goals (SDG) were adopted and a 15-year plan was developed to achieve the goals by 2030. SDG 3, “Ensure healthy lives and promote well-being for all at all ages,” addresses issues related to RMNCAH, infectious diseases, non-communicable diseases, and health systems.

2. Context in Tanzania

Tanzania’s Vision 2025 of transforming the country from a least-developed economy to a middle-income economy requires high quality human capital and the strengthening of social services, particularly for health and education. In the coming decades, the GOT’s MOHCDGEC and the GOZ’s MOH will play instrumental roles in ensuring that healthy individuals, families, and communities are contributing to the country’s broader socio-economic development. To that end, USAID/Tanzania supports and works in close collaboration with these two entities, their respective PO-RALG bodies, and other local government authorities to improve access to and use of quality health care services for RMNCAH to ensure Tanzania’s citizens are capacitated to live healthy and prosperous lives.

Improving the quality and coverage of health products and services is not necessarily sufficient to ensure that people use health services and improve health outcomes. Changes in health-seeking behaviors of individuals and communities, as well as the norms that underpin those behaviors, are also required. For example, in Tanzania, youth are particularly challenged to access and use available health care services due to insufficient knowledge and the negative attitudes, norms, and behaviors of the youth themselves as well as of other health care users, their partners, and influential adults, such as parents, teachers, and health service providers.

Similarly, at the community level, harmful social and gender norms negatively impact health-seeking behaviors and often limit clients’ access to and use of facility- and community-based services.

In Tanzania, multiple behavioral determinants underpin why youth and women of reproductive age fail to access RMNCAH services. Changing this requires addressing behavioral-related factors such as knowledge, attitudes, and inequitable gender norms, including communication between health providers and clients, families’ and couples’ communication, and the engagement of community leaders and other influencers in building trust in the health system and promoting timely use of services, and the adoption of healthy behaviors and practices. Arming communities, families, and healthcare workers with the right skills and information and creating enabling environments that support the empowerment of families, communities, and health care workers to improve RMNCAH is essential to maximizing access to and use of quality RMNCAH services to save lives and improve health.

The GOT and GOZ have made significant progress in addressing health concerns across the country, but much remains to be done to enable all Tanzanians to access quality health care services required to live a healthy and productive life. Key constraints include:

Quality of Care Challenges

● Inadequate skilled human resources in the health sector

● Shortages of commodities, medical equipment, and supplies

● Inadequate supervision and coaching in health care

● Slow adoption of global best practices and newly recommended curative and preventive interventions

● Low data quality and inadequate data use for decision-making.

Access Challenges

● Inefficient referral systems and linkages between facilities and communities

● Long waiting time for services at health facilities

● Long distances and difficult terrain

● Limited use of health insurance

● Informal payments at health facilities

Policy/Political-Related Challenges

● Limited political support at the highest level of government for FP service provision

● Resistance to expanding the role of community-based service delivery

● Limited citizen engagement in promoting public sector transparency and accountability

● Inadequate budget allocation and funds disbursement for health

Socio-Cultural Factors

● Harmful social and gender norms that affect individuals’ access to and use of services, especially for women and youth.

The GOT outlined its plans and priorities for the health sector in the MOHCDGEC’s Health Sector Strategic Plan (HSSP) IV (2015-2020) and its forthcoming successor HSSP V; National Road Map Strategic Plan to Improve Reproductive, Maternal, Newborn, Child, and Adolescent Health in Tanzania (2016-2020) (also known as One Plan II) and its forthcoming successor One Plan III; and National FP Costed Implementation Plan (2019-2023). Similarly, the GOZ outlined its plans and priorities for the health sector in the MOH’s Zanzibar HSSP III (2013/14-2018/19) and its forthcoming successor HSSP IV RMNCAH Strategic Plan (2019-2023).

In Tanzania Mainland, to improve the provision of health services at the community level and help address human resource constraints, in 2020 the MOHCDGEC developed policy guidelines for Community-Based Health and Social Welfare Services and National Operational Guidelines for Community-Based and Health Care Services. These guidelines, which are in line with the national HSSP IV, map an integrated and coordinated national approach to community-based health, and will guide operationalization of community-based health services so that the program overall becomes functional and sustainable in improving community health and social welfare.

Similarly, in 2019 the GOZ launched a new Community Health Strategy (CHS 2019), a follow-on to the strategy launched in 2011. The new strategy, which is under implementation, focuses on national scale up of the community health program in Zanzibar, including revisions of the community health volunteer national training package followed by development of the operational manual.

Over the past several years, to enhance the effectiveness of its investments and improve health outcomes, USAID/Tanzania’s Health Office moved from a disease-specific and single-service component portfolio to a more comprehensive and integrated portfolio. The Comprehensive Client-Centered Health Program (C3HP) builds on lessons learned from that experience and emphasizes on “smart integration” between components and other activities where integration is more feasible and makes more sense. All awards under C3HP will also strengthen the linkages between health facilities and the community, foster an improved enabling environment, and incorporate robust social and behavior change (SBC) interventions as a crucial component for ensuring success. Critically, C3HP also emphasizes reaching young Tanzanians with health services and health promotion messaging.

C3HP includes three related activities:

● RMNCAH Activity: This bilateral award will focus on improving the quality of RMNCAH services at the facility and community level and include community-level SBC interventions.

● HIV/TB Activities: These two bilateral awards (targeting different regions of the country) will focus on the provision of integrated HIV and TB prevention, care, and treatment services. During implementation, these two awards will integrate HIV and FP interventions as appropriate and will include community-level SBC interventions.

These three awards will be complemented by a malaria control program and a national social behavior change technical assistance award (a follow-on to the current USAID-supported Tulonge Afya activity, which ends in 2022). It is envisioned that the three C3HP activities, the malaria control program and Tulonge Afya follow on activities will synergistically collaborate, especially in areas with geographical overlap, to fast track the achievement of the overall goal of improving the health outcomes for all Tanzanians.

I. RELATIONSHIP TO USAID COUNTRY DEVELOPMENT COOPERATION

STRATEGY RESULTS FRAMEWORK

The RMNCAH and HIV/TB activities under C3HP are key to achieving USAID/Tanzania’s tentative, new strategic direction under its draft Country Development Cooperation Strategy (CDCS) for the period 2020-2025, illustrated in Figure 1, below. The draft CDCS focuses on youth (15 - 35 years) as the current and future drivers of Tanzania’s long-term development and prosperity. It emphasizes the needs of youth and young adults for quality public and private sector services that build their skills and productivity, while also focusing on the need for local leadership to create the community environment that allows young people to thrive in a way that will accelerate inclusive, broad-based growth.

Figure 1: USAID/Tanzania Country Development Cooperation Strategy Results Framework, 2020-2025

As shown above, the CDCS posits that IF Tanzania improves the foundational skills of its youth;

empowers and increases the productivity and engagement of young adults; and strengthens the ability of state and non-state actors to benefit future generations, THEN youth will be better positioned to contribute to the long-term prosperity of their country.

Following the CDCS development hypothesis, the C3HP-RMNCAH Activity will support Development Objective DO1, IR1.2 by improving availability and access to RMNCAH services through quality improvements and improved health behaviors; DO2, IR 2.1 by expanding youth access to quality information and supporting youth in taking control of their own health; DO3, IR 3.1, through mentoring, training, supportive supervision and capacity-building at various levels of the health system; and DO3, IR3.3 through strengthening linkages between health facilities and communities.

II. SCOPE OF WORK

Under the C3HP-RMNCAH activity, USAID/Tanzania seeks increased use of, demand for and access to quality integrated RMNCAH services, particularly by youth and women, leading to improved health outcomes.

To accomplish this, the Contractor must provide technical and material assistance and/or administrative and management support to the GOZ-MOH and the GOT-MOHCDGEC and PO-RALG entities, to local government authorities (district and council levels), and to health facilities to increase their capacity to manage and deliver quality RMNCAH services within the public health sector. The Contractor must also provide technical and material support to strengthen the provision of community-based health services and improve linkages between communities and health facilities. The C3HP-RMNCAH Contractor must support a set of smartly integrated RMNCAH interventions that include routine and outreach FP services, MNCAH and cervical cancer prevention (CECAP) services. In addition, the Contractor must promote social behavior change that addresses knowledge gaps, attitudes, negative social/gender norms and other barriers to using health services, thus promoting positive health-seeking behaviors, particularly for youth and women. Finally, the Contractor must support national level efforts to update and operationalize policies, procedures and guidelines related to RMNCAH services provision, including citizen involvement during their development and implementation.

The Contractor must provide these services in Zanzibar and targeted regions of Tanzania Mainland, as discussed in the section below entitled “Geographic Coverage.” The services provided, as well as the intensity required, will be determined by the Contractor in consultation with the GOT and USAID/Tanzania during annual work plan development and are expected to evolve from year to year throughout the period of performance based on needs represented by the evolving data and the availability of funds.

All C3HP-RMNCAH work implemented on Tanzania Mainland under this award must be guided by the MOHCDGEC’s National Road Map Strategic Plan to Improve Reproductive, Maternal, Newborn, Child, and Adolescent Health in Tanzania (2016-2020) (also known as One Plan II) and its forthcoming successor One Plan III, the recently launched National FP Costed Implementation Plan (2019-2023), the Community Based Health and Social Welfare Program (CBH & SWP) policy and operational guidelines, the National Multisectoral Nutrition Action Plan (NMNAP 2016-2021), National Operational Guideline for Community Based Health Care Services (2020), Quality Improvement Framework (2020-2025), National Guideline for Gender and Respectful Care Mainstreaming and Integration Across RMNCAH Services in Tanzania (2019), the Health Sector Strategic Plan IV (HSSP IV) (2016-2020) and HSSP V under development. Similarly, all interventions under this award that will be implemented in Zanzibar must be guided by MOH’s Zanzibar Health Sector Strategic Plan III (2013/14-2018/19) and its forthcoming successor HSSP IV; Zanzibar RMNCAH Strategic Plan (2019-2023), and the Zanzibar Community Health Strategy.

The goal for the C3HP-RMNCAH Activity and the strategy for achieving results are indicated in the Results Framework graphic (Figure 2), outlined in the development hypothesis, and discussed in more detail by result and sub-result, below:

Figure 2: C3HP-RMNCAH Activity Results Framework

Given the recent history of national and regional epidemics affecting Tanzania over the last decade, there is a high probability that a waterborne, zoonotic, or other deadly disease will surface in Tanzania during the period of performance. The outbreak of a serious infectious disease has the capacity to threaten progress toward achieving the objectives/outcomes under this contract given the capacity of Tanzania’s health system. Should Tanzania experience a public health crisis that directly or indirectly impacts the beneficiary population during the period of performance, the Contractor must technically and/or materially assist the subnational GOT entities and community-based organizations to prevent or reduce the spread of the illness in one or more of the following areas: (1) Risk communication and community engagement; (2) Surveillance, rapid-response teams, and case investigation; (3) Infection prevention and control;

(4) Case Management; (5) Operational support and logistics; (6) Maintaining essential health services and systems.

C3HP-RMNCAH ACTIVITY DEVELOPMENT HYPOTHESIS:

IF: (1) Beneficiaries, particularly women, youth and children, have access to quality integrated RMNCAH services in facilities and communities that are linked to ensure a continuum of care;

and IF: (2) equitable social/gender norms and practices that facilitate positive health-seeking behaviors are strengthened; and IF: (3) the right policies are in place and clients are engaged in service delivery; THEN Tanzanians, especially women and youth, will use the integrated RMNCAH services, leading to healthier lives and thriving communities.

Geographic Coverage

As indicated in the map below, the C3HP-RMNCAH Activity will focus on both MNCAH and FP in Zanzibar and five regions of Tanzania Mainland: Geita, Simiyu, Mwanza, Mara and Shinyanga. In the regions of Manyara, Katavi and Dodoma, the focus will be only on MNCH.

FP will be the only focus in the regions of Tabora, Tanga and Dar es Salaam. Target regions for support were identified based on health statistics and performance against RMNCAH indicators (i.e. low composite rates of antenatal care (ANC) early visits, four ANC visits, institutional deliveries, two doses of intermittent preventive treatment (IPT2), child immunizations, and mCPR, along with high teenage pregnancy rates, unmet need for modern contraception, etc.), as documented in the most recent TDHS and other GOT documents, and will be confirmed by USAID after consultation with the GOT and GOZ. Should needs/priorities evolve, MNCH and FP interventions may be implemented in any of the mentioned Tanzania Mainland regions and Zanzibar. To improve health outcomes and ensure that services are client-centered, when and where it makes sense, the Contractor must integrate MNCAH and FP services in the regions where both interventions are supported. The contractor must advocate for integration of MNCAH and FP services in regions where only one package of interventions is supported by this award. Further, the contractor must closely work with local government authorities in the supported regions to prioritize health facilities that the award can support mainly among public and faith-based facilities for higher RMNCAH outcomes and impact.

Ensuring client-centered health services also requires working collaboratively with activities beyond those supported by C3HP-RMNCAH. Section VII of this PWS discusses USAID’s requirements for collaboration with other USAID-supported activities as well as collaboration with activities supported by other development partners.

III. RESULT AREAS

It is anticipated that the C3HP-RMNCAH Award will contribute to the results framework as outlined in the following discussion:

Intermediate Result 1: Improved access to quality, client centered RMNCAH services

● Sub IR 1.1 – Improved access to quality health services at the facility level

● Sub IR 1.2 – Improved access to quality health services at the community level

● Sub IR 1.3 –Strengthened linkages between facility and community health services

Improved access to and use of quality, client-centered health care at both the facility and community levels is essential to improving health outcomes in the targeted regions. Depending on the context and part of the country, access to quality RMNCAH services, especially in the public sector, is affected differently by the various dimensions of access (physical accessibility, financial accessibility, and acceptability of services). Under the C3HP RMNCAH activity, the Contractor must collaborate with key stakeholders, including the GOT/GOZ at all levels, to focus on mitigating factors related to physical access and acceptability of services. The Contractor must ensure there is a continuum of care by addressing quality challenges to facility-and community-based RMNCAH care in the supported regions and by strengthening linkages between the supported health facilities and the communities they serve. Where feasible and possible, the Contractor must integrate provision of RMNCAH services and employ gender transformative approaches to make them more client centered. In addition, the Contractor must coordinate with other USAID activities working in the same regions that focus on addressing financial challenges to access.

Mandatory Result Annual Performance Standard Increased access to integrated client centered RMNCAH services

10% annual increase in number of women, youth, newborn and children in targeted regions accessing RMNCAH services.

Sub IR 1.1 – Improved access to quality health services at the facility level

The health system is challenged to deliver the quality integrated health services required to save lives and reduce morbidity and mortality, particularly among newborns, children, adolescents, and women. Access to quality integrated health services is particularly a challenge in rural areas, where, at the facility level, shortages of skilled health care staff, inadequate supervision and motivation, poor infrastructure, a shortage of medical equipment and supplies, and insufficient referral systems are most acute. Further, services are not always provided in a respectful and/or adolescent-friendly manner. This makes access to quality RMNCAH care even more difficult for beneficiaries hence highlighting the importance of outreach services to surrounding communities. Urban populations also face several barriers to accessing RMNCAH services, including direct and indirect costs that clients incur at health facilities as a result of low use of health insurance and disproportionately low availability of skilled workforce in relation to the urban population.

With the significant shortage of skilled human resources, there is a need to deliver RMNCAH services that are of high quality, “smartly integrated” and friendly, especially to adolescents.

“Smart integration” refers to provision of a combined set of interventions at logical service delivery points where services are most effectively accessed and delivered to beneficiaries.

Smartly integrated health services have the potential to respond to barriers in accessing RMNCAH services in the country. As several studies have revealed, integration of services in a one - stop model increases client satisfaction with service delivery, reduces costs associated with travel and reduces the workload of the available workforce at health facilities. The Contractor must use this approach to improve access to quality RMNCAH care.

Expected Results:

To achieve this result, the Contractor must build capacity to deliver RMNCAH services within all public health facilities in the identified regions, with a focus on improving quality and patient-centered care and treatment.

Outcome Mandatory Results

Annual Performance Standard AQL*

Targeted health facilities provide comprehensive ANC services according to GOT/GOZ guidelines o 20% increase in ANC first visits before 12 weeks of gestation age o 10% increase in ANC clients who received iron/folic acid o 30% increase in ANC clients screened for syphilis who were treated o 20% increase in ANC clients reached by nutrition-specific interventions o 20% increase in ANC clients that received IPTp3+ o 20% increase in ANC clients that attended the required number of ANC visits.

80% of standard

1.1.1

Improved access to quality maternal and newborn health services

Targeted health facilities provide emergency obstetrics and newborn care according to GOT/GOZ guidelines o 20% increase in premature babies received kangaroo mother care o 20% increase in newborn resuscitation following breathing challenges at birth o 20% increase in newborns breastfed within the first hour.

o 20% increase in Utilization of

80% of standard labor and delivery services o 10% increase in the number of women that received uterotonic for the third stage of labor o 20% decrease in the case fatality rate from direct obstetrics causes o 20% decrease in the number of fresh stillbirths o 15% increase in number of post-partum women seeking postnatal care within 48 hours.

o 20% increase in the number of Caretakers who seek appropriate care for signs and symptoms of common newborn illnesses

1.1.2

Improved quality of child health services

Children under the age of five years receive care as per the national guidelines and standards.

o 20% increase in children under 5 years that are correctly assessed and treated using the integrated management of common childhood illnesses (IMCI) algorithm o 5% increase in children receiving age-appropriate immunization services

90% of standard

1.1.3 Improved quality of adolescent and youth health care services

Targeted facilities provide youth and adolescent friendly health services (AYFHS) for RMNCAH services o 20% increase in uptake of RMNCAH services among youth and adolescents o 20% increase in health workforce that can provide AYFHS at community and facility levels

80% of standard

1.1.4 Improved quality of family planning services

Uptake of a broad range of contraceptive services based on volunteerism and informed choice in targeted health facilities o 15% increase in uptake of FP services by age categories 15-19, 20-24 and 25+ years o 15% increase in modern FP uptake by type of contraception (implants, pills condom etc.)

Service delivery points offer integrated family planning services in targeted facilities o 20% increase in uptake of FP among postpartum clients o 10% increase in uptake of FP among post abortion clients o 20% increase in uptake of FP among PLHIV in PEPFAR-supported sites o 20% increase in number of clients counselled and referred for FP

80% of standard

1.1.5 Improved quality of

CECAP

services

Service delivery points offer integrated CECAP services in targeted facilities according to national guidelines.

o 20% increase in the number of clients screened for cervical cancer by age categories.

o 30% increase in treated clients with precancerous lesions after screening.

o 10% increase in referred clients with confirmed cervical cancer.

80% of standard

* For example, an AQL of 80% for a standard requiring 20% achievement means 16% of achievement is acceptable.

Sub IR 1.2 – Improved access to quality health services at the community level

To ensure that key RMNCAH interventions and approaches are equitable, relevant and acceptable to local communities, it is critical to understand and address barriers to demand and access health services. When appropriately designed and implemented, community health worker (CHW) programs play an important role in reducing inequitable access to services by bringing information, services, and supplies to women and men in the communities where they live and work rather than requiring them to visit health facilities. CHWs can be particularly successful in increasing the use of contraception, especially where unmet needs are high, access is low, and geographic or social barriers to the use of RMNCAH services exist. CHWs can also perform case management and recognize key danger signs in maternal and child health, boosting referral systems and supporting timely care-seeking behaviors. CHW can also play a key role in promoting good nutrition for pregnant women, ensuring deliveries are assisted by a skilled attendant in a health facility, carrying out postnatal home visits of mothers and their newborn babies, etc.

In Tanzania, the services offered by community health workers are limited and CHWs do not always have the training or supplies/equipment needed to perform their services. There is no well-established system to coordinate and standardize the work done by CHWs operating in different communities in the country, greatly affecting the impact of their work.

To address these issues, the GOT is rolling out the Community Based Health and Social Welfare Program and transitioning the community case workers and volunteers into a formal CHW program aligned with the Policy Guidelines for Community Based Health and Social…