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					Cara International Consultancy Ltd.                            Tender for AFGH on Aid effectiveness

                                                                          40 b Ringstead Road
                                                                          SM1 4SJ
                                                                          +44 (0) 20 8 6426526

                                                                          November 22nd 2007
Action for Global Health
c/o ActionAid EU Office
Rue du Commerce 41
Brussels 1000, Belgium

Dear Simon,
          Re: Cara International Consultancy Ltd. tender for policy work on an
             Analysis of EU Aid Effectiveness for Health: policy and practice

Cara International Consultancy Ltd. was established in August 2006. Its Directors have over forty
years of experience in International Development especially in the areas of aid, policy, health,
HIV, social development, financial management and systems support. Cara consultants have
technical skills in health, HIV, accountancy, training, human resource development and
management, grant management and tender support, report writing, research and advocacy.

To date Cara has been contracted to provide ongoing technical support, over five years, to a DFID
funded (£19 million pounds) child health and social development programme in northern Nigeria.
Cara is also supporting a consortium to prepare a $30 million dollar maternal health programme
for Nigeria to be funded by NORAD. Cara recently completed an inclusive stakeholder
consultation and report on behalf of WHO on maternal health (including aid modalities) for the
UK International Development Committee. Cara consultants deliver lectures and training on
subjects such as: International Health in UCL, Keele, Edinburgh and Liverpool Universities (on
subjects such as health financing, global health partnerships, gender and health, the right to
health, HIV and health systems support in fragile states), Participatory approaches to Learning
and Action (PLA) and financial training on grants management and establishing financial

Cara’s international health adviser and Director, Regina Keith, has recently been selected as the
maternal health adviser to the UK International Development Committee. Cara staff provide
technical and policy support to NGOs like Save the Children and PLAN and are part of global
partnerships like the Countdown to 2015, the Partnership for Maternal Child and Newborn
Health, Women Deliver Campaign, White Ribbon Alliance, and the Right to Health Campaign.
Cara Directors are represented on senior advisory panels such as: Primary Health Care (Madrid)
and the Strategic Advisory Group of Experts on Immunization (Geneva).

Confidential                                 Page 1                                    3/22/2010
Cara International Consultancy Ltd.                             Tender for AFGH on Aid effectiveness

Cara’s relevant experience
Cara has recently completed a report on maternal health including an analysis of the efficacy of
aid modalities for maternal health, with recommendations agreed by 21 stakeholder organisations.
Organisations involved in the consultation include Save the Children, MSF, World Vision, Plan,
Action for Global Health, Interact, MSI, IPPF and others..

Cara’s Director, Regina Keith, has worked with global organisations on health policy and health
aid modalities for over seven years. She supported the first northern NGO representative to the
GFTAM, ensuring the active voice and participation of 45 NGOs. She has also represented
northern NGOs at GAVI NGO partners meetings, the World Health Assembly and as part of the
core working group of the Partnership for Maternal Child and Newborn Health. She was a core
member of a five person steering group responsible for the 2005 Child Survival report and
meeting: Countdown to 2015. In 2004 she co-authored a joint NGO report entitled: 80 million
lives: meeting the maternal and child survival MDGs, in which 20 UK based NGOs agreed on
policy options for maternal and child health. The report was launched in the Parliament by
Baroness Amos (then Secretary of State for International Development), and welcomed by DFID
and other health stakeholders as a welcome sign of NGOs speaking with one voice. Through her
work as senior health adviser in Save the Children UK she supported the development of the 2005
EU aid analysis report entitled: We do roads not children and the development of the Save the
Children supported Eurodad report on aid effectiveness. She has met with MEPs on increasing
health aid from Europe, promoting access to health care free at the point of access and
encouraging European countries to compensate developing nations for human resources recruited
from the poorest nations. She has also supported research in developing countries which has led
to national and global health policy changes.

Cara personnel involved
Regina Keith would be the lead technical adviser from Cara supporting the completion of this
report. Regina is a nurse midwife with a Masters in International Health and over 28 years
experience. She has worked for NGOs like Save the Children and VSO as well as for
organisations like DFID, WHO, APSO, NHS and the US Embassy in Botswana. She has written
reports on health financing, human resources for health, aid effectiveness in health, health
advocacy and technical health papers for the BMJ and others. She has an extensive European
network of health contacts in Brussels, France. Italy, Switzerland, Netherland, Norway and
Holland. She has written briefs for the EU and presented questions and reports to the MEPs and
EU stakeholders in Brussels. See annex two for cv.

Regina would be supported by advisers from Cara International Consulting Ltd., and Cara would
establish a key advisory team to support the report at key stages of its development (planning,
completion, and policy recommendations). This technical group would be formed of European
technical health experts, health economists, international development experts including
economists, political experts, and representatives from global health partnerships (like GAVI and
GFATM) and WHO. See annex one for short bios of some of the technical group participants.

Cara’s proposed approach to this work

After the initial teleconference with the AFGH project team in early December, the Cara
consultant would carry out a rapid literature review of all relevant reports on health aid and write
a summary (four pages) highlighting the major issues arising with present gaps and questions to
be answered by the report. Cara would then complete the outline for section one along with
questions by the December 10th deadline. Cara consultant would then circulate the summary,

Confidential                                  Page 2                                     3/22/2010
Cara International Consultancy Ltd.                              Tender for AFGH on Aid effectiveness

outline and questions to AFGH project management team, and policy working group and to the
technical advisory team to harness their views on the content and the direction of the report, prior
to the December 19th AFGH Madrid meeting. This work will also help to identify key areas for
case studies required from partners. Cara recommends that one full day be assigned for the
December 19th meeting. It would be important for participants to read the summary prior to the
meeting in an attempt to ensure more effective dialogue and ensure ownership of the report by all
stakeholders. This will also enable AFGH to ascertain where consensus lies regarding positions
for aid effectiveness. Positions would then be completed and circulated in time for the Davos
meeting (which has health aid as a topic) and the WHO Executive Board meeting. This will
enable AFGH to attend these sessions with key questions and positions.

By January 10th the key questions and areas to be covered by case studies should be identified and
agreed so that countries can begin to recruit their consultants. The first draft of section one of the
report will be submitted by the 1st of February to the AFGH policy working group. Cara would
continue to provide email support and advice to the countries to ensure that their case studies
were completed by March 1st. Countries will be encouraged to have the comments on section one
completed by this time. In Mid March Cara will bring together the above mentioned Cara
technical advisory group to ensure the report explores aid effectiveness from the political,
technical, financial and civil society view points, incorporating all lessons learned and laying out
the possible ways forward for increasing health aid effectiveness. Cara will present the first draft
by the 21st of March including possible recommendations. In early April Cara would like to hold
another meeting in Brussels with partners to present and agree upon the recommendations from
the report and iron out any unresolved issues. In April two revised editions of the report will be
circulated to partners with final comments to Cara by the 17th of April. The Cara consultant will
attend and support the week long meeting from April 21st with AFGH partners to support the
development of the advocacy strategy, and the final draft report would be delivered to the policy
team on April 28th 2008. Cara would then be available for proof reading and support as required
in the run up to the publication of the report.

What are the salient debates on aid effectiveness and aid for health

The 2006 OECD analysis of progress of the implementation of the Paris Agreement found that:
“Although donor agencies have made efforts to implement the Paris Declaration, there is a
significant ‘disconnect between headquarters policies and in-country practices, as illustrated by
continued donor-driven technical cooperation and lack of visible progress on untying aid’ The
report suggests that donor headquarters need to provide leadership, acknowledge the costs of
delivering aid more effectively, focus incentives on development outcomes and review legal or
procedural frameworks that impede implementation. Other issues which are hotly debated include
how to ensure there is increased global and European (political) commitment to addressing
the following :

     Increased and more predictability of funding for health especially for systems
      strengthening and human resources for health
     Capturing lessons learned regarding effective mechanisms for increasing aid in an
      empowering way (external health funds versus budget or national health sector support)
     Enhancing country ownership: Strengthening national ownership over development
      policies and procedures is essential to enhancing aid effectiveness
     Greater alignment between PRSPs, Mid term expenditure plans and Aid
     Issues around fiscal space need to be addressed on a country by country basis – there can
      be no blue print approach
     Increased harmonisation between aid partners and global health partnerships.

Confidential                                   Page 3                                     3/22/2010
Cara International Consultancy Ltd.                            Tender for AFGH on Aid effectiveness

    Reform technical assistance to ensure that it meets needs identified by the recipient,
     builds real capacity on the ground and uses local systems wherever possible.
    Developing more effective indicators to measure harmonisation over time
    Improved aid architecture essential especially around
           o Reducing tied aid
           o More effective balance of aid dispersal (reduce donor orphans)
           o Measurement of progress (time bound targets)
           o Governance and accountability
           o Reviewing impact of aid conditionality (reduce prevalence of conditionality
               which has a negative impact)
           o More attention on Voice and Accountability and increased Transparency of
               donors and International Financial Institutions
                  Issues of gender, equity and poverty need greater attention and
                  Resources need to be made available for civil society to measure and hold
                   their governments accountable for health promises made
                  Global partnerships need to be held more accountable to improve
                   adherence to global health partnership principles
                  The need to develop an equity (or health impact) lens for all policies
                   including trade and economic policies
                  Reduce the administrative and transaction costs of aid.
Cost of report

Budget breakdown:
 Activities                                                                       Costs
 Consultant’s fee for literature review, consultation and support to case study   £10,000
 countries, report writing and amendments and attendance at 3 AFGH
 meetings as included in the tender.
 Cara overhead costs: printing, telephone charges and in country travel costs     £2000
 Technical Advisory Group costs for support and one face to face meeting          £2000

 Total Costs (in UK pounds)                                                       £14,000

As per the tender AFGH will cover all costs of travel and attendance of Cara consultant to and
from AFGH meetings as well as all costs associated with the printing, translation editing and
copy editing of the report hence these costs are not included in this estimate.

Cost of completing the report will be £14,000 (Cara is presently not VAT registered therefore
there will be no VAT costs) to be paid in four installments.
        £2000 to be paid to Cara International Consulting Ltd. on December 10th 2007 upon
        completion of initial literature review and report outline work for section one.
        Second installment of £5000 to be paid on February 1st upon submission of the first draft
        of section one.
        Third installment of £5000 to be paid on March 21st following submission of first draft.
        Final £2000 to be paid on April 28th upon submission of final report.

Cara is willing to negotiate to reduce costs through: swapping a virtual meeting of the technical
advisory group instead of a face to face meeting, reducing the number of days support by this
group, and reducing the amount of time available for consultation, review and country support.
These modifications could reduce the overall bid cost if reduction is required.

Confidential                                  Page 4                                    3/22/2010
Cara International Consultancy Ltd.                           Tender for AFGH on Aid effectiveness

Annex one: Short biographies of some of the Technical Advisory Group members

        Technical health adviser and policy: Regina Keith (Irish/ American)
            o Cara Director and international health expert in areas of health financing, global
                health partnerships, health policy and advocacy, maternal and child health and
                social determinants of health. Authored multiple reports both advocacy and
                technical on health financing and maternal and child health.
        Political adviser: Eaominn Taylor (English/Irish)
            o Freelance consultant working as a political analyst. Employed by DFID for over
                20 years. Engaged in the review of the Paris Agreement in 2006.
        Economic and aid effectiveness adviser: Sarah Hague(English)
            o Economist working presently for Save the Children UK on poverty and aid
                effectiveness. Previously worked with the World Bank. Participated in the design
                and consultation on the Paris Agreement on aid effectiveness.
        European aid flows adviser: Karl Blanchett (French)
            o French doctor presently carrying out PHD with LSHTM on health financing.
                Experience working with MSF, Save the Children and other NGOs. Has written
                reports on OECD health funding flows in 2007.
        Health Economist and academic adviser: Chantal Morel (French / American)
            o Health economist with experience working for LSHTM, Save the Children and
                others especially in the areas of health financing mechanisms, health research and
        EU aid flows adviser: Costanza De Toma (Italian)
            o Advocacy expert with experience of working with BOND on EU matters
                including health funding. Completed a report in 2005 for Save the Children
                Alliance on EU health funding entitled: “ We do roads not children”
        HIV and Gender adviser: Caroline Nicolson (Scottish)
            o Teacher with an MSc in Gender and Health. Has worked with VSO Action Aid
                and Save the Children in the area of HIV, gender, education and management.
                Experience of the impact of national aid modalities mostly in Africa and
                preparing consortia bids for PEPFAR and GFATM.
        HIV and GFATM adviser: Gopa Nair (Kerala)
            o Doctor with over ten years HIV experience in Asia. Has worked with IPPF and
                Save the Children and others on HIV. Has participated in GFATM analysis and
                HIV Alliance board for Save the Children. Experience of supporting bids for the
                GFATM and PEPfAR.
        Financial tracking and grants advice: Andrew Keith (Scottish)
            o Financial Director with FCCA and MSc in Human Resource Management and
                Development. Has worked with Plan, Farm Africa, Save the Children, DFID,
                UNDP and VSO. Has supported successful bids to the GFATM and managed
                grant and financial systems support and establishment in Africa Asia and Latin

Confidential                                 Page 5                                    3/22/2010
        Cara International Consultancy Ltd.                                 Tender for AFGH on Aid effectiveness

        Annex two:
                                  Regina Keith RGN RM RPN MSc International Health
                               Tel: +44 7962127068 Email:

Senior Health Policy Adviser:
Maternal and Child Health, Health Financing, Health Systems Management including human resource management
and motivation, Delivery of Health Services in Difficult Environments, Reproductive Health and HIV, Impact of
Macroeconomic Policies on Health, Health financing in low income countries, International Health including
Advocacy, Monitoring and Evaluation of health programmes and research, Managing organisation change
processes, Nursing, midwifery, nurse practitioner, health system research and social development and participatory
approaches towards development.

Senior Advisory Positions
                2007/8 Maternal Health Adviser to UK IDC Parliament (2007/8)
                Executive committee member of International Child Health and Poverty Group 2002-2007
                Editorial team for Real Health News (2005-present)
                WHO Review of PHC – Meeting of Experts Madrid 2005
                Strategic Advisory Group of Experts on Immunisations since 2003
                Core member effective interventions working group–Partnership for Maternal Child Newborn
                Steering Group Member for the Countdown to Child Survival Meeting and Report 2005 and 2007
                LSTM Board Member 2002-2004
05/07-present     Cara International Consulting Ltd.              Director – International Health
                  International Development Advisers              WHO consultation on maternal health
                  Surrey UK                                       Save the Children technical adviser DFID programme
 2001 –2007         Save the Children UK                           Senior Health Policy Adviser
                    1 St John’s Lane                               Health policy, research and advocacy for health
                    Farringdon                                     programmes in over 30 countries (Including Nigeria,
                                                                   Sierra Leone, Liberia, Sudan, Ethiopia, Uganda,
                                                                   Tanzania, Angola, Bangladesh, Laos, Cambodia,
                                                                   China and South Africa)
 2000 – 2001        National Lotteries Grants Commission           Grant Assessor
                    London UK                                     International Health Grant Assessor – Africa and Asia
 1998 –1999          APSO – Irish Aid                                 Primary Health Care Coordinator
                     Chikun LGA Area, Kaduna, Northern Nigeria
 Jan. 1997 –        Esk Valley Emergency Services                     Emergency Treatment Room Sister
 December 97        Bonnyrigg Health Centre
                    Midlothian, Scotland
 1995 –1996         American Embassy Health Unit                      Nurse Practitioner
                    Gaborone                                          HIV and health promotion programme
 1994 - 1995        Gaborone Private Hospital                         Nurse Midwife
                    Gaborone                                          UNICEF Breastfeeding Adviser
 1991 - 1993       Muirhouse Medical Group                            Practice Nurse - Team Leader G grade
                   Edinburgh Scotland
 1988 - 1991       Combo West District                                V. S. O. Health Care Manager
                    Methodist Mission Clinics
                    The Gambia
 1985 - 1988       Barking Maternity Hospital UK and                  Staff Midwife and Staff Nurse in UK and Ireland
                   Cork University Hospital
                   Wilton Park
                    Cork Ireland

        Confidential                                      Page 6                                       3/22/2010
        Cara International Consultancy Ltd.                                  Tender for AFGH on Aid effectiveness

09/99-08/00         Centre for International Health Studies          MSc. International Health
                    Edinburgh Scotland
Feb 1993            New York State University                        Registered Professional Nurse (RPN)
                    NCLEX exams for State Boards
1986- 1987          Barking Maternity Hospital                       Registered Midwife (RM)
                    Upney Lane
                    Barking Essex
                    IG11 9LX
1982 - 1985         Cork University Hospital                         Registered General Nurse (RGN)
                    Wilton Park
                 Lecturer in Gender and Health (BSc Int Health)– Nuffield Leeds University
                 Lecturer in Human resources for Health and NGOs role in Health – Keele University
                 Lecturer in Health Financing – BSc Programme in International Health at UCL
                 Lecturer in Global Health Partnerships – MSc in International Health - Edinburgh 2002/3
                 Lecturer in Emergency health at Liverpool School of Tropical Medicine 2002-2005
                 Mother tongues: English / Working knowledge: French / Fair: Mandinka, Hausa and Spanish

Selected Publications
        Keith R (2000) Perceptions of quality: a constructivist inquiry into community health workers perceptions
        of quality in Kaduna State Northern Nigeria QMUC MSc Thesis

        Starling M, Walt G, Keith R, Heaton A (2002) New Products into Old Systems: the impact of GAVI from a
        country’s perspective Save the Children UK

        Fustukan S, Keith R, Penrose A (2003) 80 million lives: meeting the health related MDGs for child and
        maternal survival Save the Children UK and CAFOD for the Grow Up Free from Poverty Coalition

        Mc Nay K, Keith R, and Penrose A (2004) Bucking the trend: good health at low cost; challenges and
        policy implications for Sri Lanka in the 21st Century Save the Children UK

        James C, Morris S, Keith R, Taylor A (2005) A Simulation model to measure the impact of user fee
        abolition in twenty SSA countries British Medical Journal October 2005

        Keith R and Shackleton P (2006) Paying with their lives: the cost of illness for Africa’s children Save the
        Children UK

        Blanchett K, Keith R, Shackleton P (2006) One million more: report from the Mobilising the African
        Diaspora meeting in March 2006 Save the Children UK

        Keith R (2007) Can the Commonwealth Nations lead the way towards universal coverage Commonwealth
        Health Ministers Book 2007 Commonwealth Secretariat London UK

        Morel C, Keith R (2007) Can Social Health Insurance work in Sub Saharan Africa: briefing paper Save
        the Children UK

        Keith R (2007) WHO report from stakeholder consultation to feed into International Development
        Committee’s Maternal Health Inquiry Cara International Consulting Ltd on behalf of WHO

        Confidential                                      Page 7                                         3/22/2010

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