USAID CHEGAR Sol_72065620R00008.pdf

Date Issued:

Closing Date for

Submission of

Questions:

April 6, 2020

April 20, 2020 @ 05:00 pm (Maputo time)

Closing Date for

Receipt of

Proposals:

May 21, 2020 @ 05:00 pm (Maputo time)

Subject:

Request for Proposals (RFP) No. 72065620R00008 for USAID

Commodities for Health: Ensuring Guaranteed Access and

Reliability (CHEGAR)

Dear Prospective Offerors, The United States Government, represented by the United States Agency for International Development

(USAID) Mission in Mozambique is seeking a proposal from qualified organizations interested in providing the services to improve the availability of medical commodities in all clinics and hospitals, including those in remote and rural areas, to achieve USAID and Mozambique Ministry of Health goals as described in the attached solicitation.

The authorized USAID Principal Geographic Code for this solicitation is 935. The NAICS Code for this solicitation is 923120.

USAID anticipates awarding one cost plus incentive fee – performance incentive (CPIF-PI) type contract as a result of this solicitation. The award is for a period of 3 years, with no option years, subject to availability of funds. The maximum amount of the contract (costs and fees) is estimated to fall between $20 and $24.9 million subject to availability of funds and successful performance. Nevertheless, revealing the total estimated cost for the contract does not mean the Offerors should necessarily strive to meet the maximum amount; offerors must propose costs that are realistic and reasonable for the activity. Cost-effective approaches to achieving the program objectives stated in the government requirement are highly encouraged.

USAID encourages participation to the maximum extent possible of local and locally established organizations as prime or subcontractors in accordance with Section L.

The RFP and any amendments to this solicitation will be issued and posted on the Federal Business

Opportunities website at https://beta.SAM.gov. It is the Offeror’s responsibility to check the website periodically for official updates and amendments to the solicitation. It is the responsibility of the recipient of this solicitation document to ensure that it has been received from the internet in its entirety and USAID bears no responsibility for data errors resulting from transmission or conversion processes.

Offerors are encouraged to read the entire solicitation, which includes the closing date and time, all pertinent contract requirements, and the conditions and instructions required for submitting a proposal. Pursuant to Block

12 of Standard Form 33 of this RFP, USAID requires that offers stay valid for 270 days from the closing date of this RFP.

https://beta.sam.gov/

Any questions regarding this RFP are to submitted in writing to the attention of Ms. Nelly Mahanjane via email nmahanjane@usaid.gov with a copy to eluma@usaid.gov by 03:00 p.m. Maputo Time on April 20, 2020. No questions will be accepted after this date. Each email must contain a subject line, which clearly indicates the name of the offeror and the solicitation number. Any amendments to this solicitation will be furnished via https://beta.SAM.gov.

Proposals in response to this RFP are due by electronic mail to nmahanjane@usaid.gov with a copy to eluma@usaid.gov no later than 05:00 p.m. Maputo Time, on May 21, 2020.

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

Government. Furthermore, the Government reserves the right to make an award without discussions.

Thank you for your interest in USAID programs.

Sincerely, Eyole Luma

Supervisory Contracting Officer

USAID/Mozambique mailto:nmahanjane@usaid.gov mailto:eluma@usaid.gov https://beta.sam.gov/ mailto:eluma@usaid.gov

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

04/06/2020 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) 05/21/2020

(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 86-92

CONTRACT ADMINISTRATION DATA 42-45

40 SPECIAL CONTRACT REQUIREMENTS 46-70

CONTRACT CLAUSES 71-84

LIST OF ATTACHMENTS 85

INSTR., CONDS., AND NOTICES TO OFFERORS 93-103

EVALUATION FACTORS FOR AWARD 104-108

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

TABLE OF CONTENTS

PART I – THE SCHEDULE

SECTION B - SUPPLIES OR SERVICES AND PRICE/COSTS

B.1 PURPOSE

B.2 CONTRACT TYPE AND SERVICES

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

B.4 COST SCHEDULE

B.6 COST REIMBURSABLE

SECTION C - STATEMENT OF WORK

C.1 INTRODUCTION

C.2 BACKGROUND

C.3 PURPOSE AND ACTIVITIES

C.4 TECHNICAL APPROACH

C.5 COLLABORATING, LEARNING AND ADAPTING (CLA)

C.6 MONITORING AND EVALUATION

SECTION D - PACKAGING AND MARKING

D.1 AIDAR 752.7009 MARKING (JAN 1993)

D.2 BRANDING AND MARKING POLICY

D.3 BRANDING STRATEGY

D.4 MARKING

SECTION E - INSPECTION AND ACCEPTANCE

E.1 INSPECTION AND ACCEPTANCE

E.2 MONITORING AND EVALUATION

E.3 PERFORMANCE STANDARDS

SECTION F – DELIVERIES OR PERFORMANCE

F.1 NOTICE LISTING CONTRACT CLAUSES INCORPORATED BY REFERENCE

F.2 PERIOD OF PERFORMANCE

F.3 PLACE OF PERFORMANCE

F.4 PERFORMANCE STANDARDS

F.5 REPORTS AND DELIVERABLES

F.6 MANAGEMENT APPROACH/KEY PERSONNEL

F.7 TECHNICAL APPROVAL REQUIREMENTS

F.8 AUTHORIZED WORKWEEK

F.9 AIDAR 752.242-70 PERIODIC PROGRESS REPORTS (OCT 2007)

F.10 AIDAR 752.7005 SUBMISSION REQUIREMENTS FOR DEVELOPMENT EXPERIENCE

DOCUMENTS (SEPTEMBER 2013)

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

G.2 CONTRACTING OFFICER'S AUTHORITY

G.3 ADMINISTRATIVE CONTRACTING OFFICE

G.4 CONTRACTING OFFICER’S REPRESENTATIVE (COR)

G.5 TECHNICAL DIRECTION/RELATIONSHIP WITH USAID

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

G.6 PAYMENT METHOD AND INVOICES

SECTION H - SPECIAL CONTRACT REQUIREMENTS

H.1 NOTICE LISTING CONTRACT CLAUSES INCORPORATED BY REFERENCE

H.2 FOREIGN GOVERNMENT DELEGATIONS TO INTERNATIONAL CONFERENCES (JAN 2002) ... 46

H.3 AIDAR 752.225-70 SOURCE AND NATIONALITY REQUIREMENT (FEB 2012)

H.4 AIDAR 752.7004 EMERGENCY LOCATOR INFORMATION (JUL 2007)

H.6 AUTHORIZED GEOGRAPHIC CODE

H.7 LOGISTIC SUPPORT

H.8 NONEXPENDABLE PROPERTY PURCHASES AND INFORMATION TECHNOLOGY RESOURCES

H.9 LANGUAGE REQUIREMENTS AND REPORTING

H.10 AIDAR 752.211-70 LANGUAGE AND MEASUREMENT (JUN 1992)

H.11 SUBCONTRACTING PLAN REPORT FOR INDIVIDUAL CONTRACTS AND SUMMARY

CONTRACTING REPORT

H.12 AIDAR 752.204-72 ACCESS TO USAID FACILITIES AND USAID'S INFORMATION SYSTEMS

(MAY 2016) (DEVIATION NO. M/OAA-DEV-AIDAR-16-2c)

H.13 CLOUD COMPUTING - AAPD 2016-02 (APRIL 2018)

H.14 AIDAR 752.222-70 USAID DISABILITY POLICY - (DEC 2004)

H.15 AIDAR 752.7007 PERSONNEL COMPENSATION (JUL 2007)

H.16 ADDITIONAL REQUIREMENTS FOR PERSONNEL COMPENSATION

H.17 AIDAR 752.7031 LEAVE AND HOLIDAYS (OCT 1989)

H.18 WORKER'S COMPENSATION INSURANCE (DEFENSE BASE ACT). (DEC 1991)

H.19 MEDICAL EVACUATION (MEDEVAC) SERVICES (JUL 2007)

H.20 CONSENT TO SUBCONTRACTS

H.21 GOVERNMENT FURNISHED FACILITIES OR PROPERTY

H.22 AIDAR 752.7013 CONTRACTOR-MISSION RELATIONSHIPS (OCT 1989)

H.23 EXECUTIVE ORDER ON TERRORISM FINANCING (MAR 2002)

H.24 SUBCONTRACTING PLAN AND THE SF 294 – SUBCONTRACTING REPORT FOR INDIVIDUAL

CONTRACTS AND SF 295 – SUMMARY CONTRACTING REPORTS

H.25 LIMITING CONSTRUCTION ACTIVITIES (AUGUST 2013)

H.26 SUBMISSION OF DATASETS TO THE DEVELOPMENT DATA LIBRARY (DDL) (OCTOBER

2014) 59

H.27 AIDAR 752.7032 INTERNATIONAL TRAVEL APPROVAL AND NOTIFICATION

REQUIREMENTS (APR 2014)

H.28 BUSINESS TRAVEL

H.29 ELECTRONIC PAYMENT SYSTEM

H.30 ENVIRONMENTAL COMPLIANCE

H.31 FAR 52.203-18 PROHIBITION ON CONTRACTING WITH ENTITIES THAT REQUIRE CERTAIN

INTERNAL CONFIDENTIALITY AGREEMENTS REPRESENTATION (JAN 2017)

H.32 USAID-FINANCED THIRD-PARTY WEB SITES (NOVEMBER 2017)

H.33 AIDAR 752.7101 VOLUNTARY POPULATION PLANNING ACTIVITIES (JUNE 2008) (AAPD 08-

01) 64

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

H.34 AIDAR 752.245-71 TITLE TO AND CARE OF PROPERTY (APR 1984)

H.35 USAID IMPLEMENTING PARTNER NOTICES (IPN) PORTAL FOR ACQUISITION

H.36 CONSCIENCE CLAUSE IMPLEMENTATION (ACQUISITION) (AAPD 12-04 FEBRUARY 2012) . 68

H.37 CONDOMS (ACQUISITION) (AAPD 12-04 JUNE 2005)

H.38 PROHIBITION ON THE PROMOTION OR ADVOCACY OF THE LEGALIZATION OR

PRACTICE OF PROSTITUTION OR SEX TRAFFICKING (ACQUISITION) (AAPD 12-04 APRIL 2010)

PART II - CONTRACT CLAUSES

SECTION I - CONTRACT CLAUSES

I.1 NOTICE LISTING CONTRACT CLAUSES INCORPORATED BY REFERENCE

I.2 52.203-99, PROHIBITION ON CONTRACTING WITH ENTITIES THAT REQUIRE CERTAIN

INTERNAL CONFIDENTIALITY AGREEMENTS (DEVIATION 2015-02)

I.3 52.204-1 APPROVAL OF CONTRACT (DEC 1989)

I.4 52.216-10 INCENTIVE FEE (JUN 2011)

I.5 52.217-8 OPTION TO EXTEND SERVICES (NOV 1999)

I.6 52.222-50 COMBATING TRAFFICKING IN PERSONS (MAR 2015)

I.7 52.227-23 RIGHTS TO PROPOSAL DATA (TECHNICAL) (JUNE 1987)

I.8 FAR 52.247-67 SUBMISSION OF TRANSPORTATION DOCUMENTS FOR AUDIT (FEB 2006)

I.9 AIDAR 752.7037 CHILD SAFEGUARDING STANDARDS (AUG 2016)

I.10 52.243-7 NOTIFICATION OF CHANGES (APR 1984)

I.11 FAR 52.222-2 PAYMENT FOR OVERTIME PREMIUMS (JUL 1990)

I.12 FAR 52.222-56 – CERTIFICATION REGARDING TRAFFICKING IN PERSONS COMPLIANCE

PLAN (MAR 2015)

I.13 752.211-70 LANGUAGE AND MEASUREMENT (JUN 1992)

I.14 FAR 52.229-8 TAXES – FOREIGN COST REIMBURSEMENT CONTRACTS (MAR 1990)

I.15 752.252-2 REFERENCE (MAR 2015)

PART III - LIST OF DOCUMENTS, EXHIBITS AND OTHER ATTACHMENTS

SECTION J – LIST OF ATTACHMENTS

SECTION K - REPRESENTATIONS, CERTIFICATIONS, AND OTHER STATEMENTS

K.1 NOTICE LISTING SOLICITATION CLAUSES INCORPORATED BY REFERENCE

K.2 52.203-98 PROHIBITION ON CONTRACTING WITH ENTITIES THAT REQUIRE CERTAIN

INTERNAL CONFIDENTIALITY AGREEMENTS REPRESENTATION (APR 2015)

K.3 52.204-8 ANNUAL REPRESENTATIONS AND CERTIFICATIONS (APR 2016)

K.4 52.209-11 REPRESENTATION BY CORPORATIONS REGARDING DELINQUENT TAX LIABILITY

OR A FELONY CONVICTION UNDER ANY FEDERAL LAW (FEB 2016)

K.5 52.204-19 INCORPORATION BY REFERENCE OF REPRESENTATIONS AND CERTIFICATIONS

(DEC 2014)

K.6 52.215-6 PLACE OF PERFORMANCE (OCT 1997)

K.7 52.230-1 COST ACCOUNTING STANDARDS NOTICES AND CERTIFICATION. (OCT 2015)

K.8 52.230-7 PROPOSAL DISCLOSURE--COST ACCOUNTING PRACTICE CHANGES (APR 2005)

K.9 INSURANCE - IMMUNITY FROM TORT LIABILITY

K.10 AGREEMENT ON, OR EXCEPTIONS TO, TERMS AND CONDITIONS

K.11 SIGNATURE

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

SECTION L - INSTRUCTIONS, CONDITIONS, AND NOTICES TO OFFERORS

L.1 52.252-1 SOLICITATION PROVISION INCORPORATED BY REFERENCE (FEB 1998)

L.2 NOTICE LISTING SOLICITATION PROVISIONS INCORPORATED BY REFERENCE

L.3 52.215-1 INSTRUCTIONS TO OFFERORS—COMPETITIVE ACQUISITION (JAN 2017)

L.4 52.216-1 TYPE OF CONTRACT (APR 1984)

L.5 52.232-38 SUBMISSION OF ELECTRONIC FUNDS TRANSFER INFORMATION WITH OFFER (JUL

2013) 97

L.7 52.233-2 SERVICE OF PROTEST (SEP 2006)

L.8 GENERAL INSTRUCTIONS TO OFFERORS

L.9 PROPOSAL PREPARATION AND SUBMISSION INSTRUCTIONS

SECTION M - EVALUATION CRITERIA FOR AWARD

M.1 GENERAL INFORMATION

M.2 TECHNICAL PROPOSAL EVALUATION CRITERIA

M.3 COST PROPOSAL EVALUATION (WILL BE REVIEWED SEPARATELY)

M.4 DETERMINATION OF THE COMPETITIVE RANGE AND CONTRACT AWARD

M.5 SOURCE SELECTION

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

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 (CPIF) 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

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

Incentive Metrics

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 (CHEGAR)

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

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 (CHEGAR) vaccine-preventable diseases are the main causes of child mortality, with malaria contributing to one-third of deaths. Forty-three percent of 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

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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.

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).

BSR. ‘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 (CHEGAR)

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 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:

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

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

3. 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).

4. 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.

5. 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.

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

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

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 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.

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

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.

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

14 Depending on availability of funds

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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.

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.

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

C.3.3 Results, Activities, And Milestones The table below summarizes the objectives, results, key activities and indicators of this activity.

Objectives Results (Outputs) Key Activities Targets

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

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.

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 (CHEGAR)

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…