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Task Order Request for Proposals Performance Based Statement of Work Positive Change: Public Private Partnerships Program (PC4) Summary of Procurement The purpose of this procurement is to obtain the services of a Contractor under a Task Order pursuant to the “Private Sector Project” indefinite quantity contract (IQC) managed by USAID’s Global Health Bureau for a four year period to help the USG achieve targets of the Emergency Program For AIDS Relief and to provide support to the treatment of Tuberculosis. The objective of the Task Order is to obtain technical services that will expand access to affordable and quality health care packages delivered by the private sector to mass markets of moderate and low income individuals, with specific emphasis on three key strategies: i) fostering private sector partnerships to address HIV/AIDS and Tuberculosis; ii) promoting social franchising to improve quality of private sector care in HIV/AIDS and Tuberculosis; and iii) targeted social marketing to high risk groups to prevent new HIV infections. The Task Order is planned for a four year period at a minimum US$700,000/year with significant increases in out years, subject to: i) continued satisfactory achievement of contract milestones and targets; ii) approval of proposed plans by the State/Global AIDS Coordinator (S/GAC); iii) availability of funds; and iv) mutual agreement to proceed. 1. Background: Emergency Plan for AIDS Relief The U.S. Government (USG) is initiating implementation of the Emergency Plan for AIDS Relief strategy. The goals of the Emergency Plan strategy, worldwide, are to: Prevent 7 million new HIV infections; Treat at least 2 million HIV-infected people; and Care for 10 million HIV-affected individuals and orphans and vulnerable children affected by HIV and AIDS
The Emergency Plan for AIDS Relief is a $15 billion, 5-year unified government initiative, directed by the Office of the Global AIDS Coordinator in the Department of State (O/GAC), and implemented in collaboration with the U.S. Department of State (DOS), the U.S. Agency for International Development (USAID), the Department of Health and Human Services (HHS), the Department of Defense (DOD), and other USG Agencies. Fourteen countries were initially selected to be part of the initiative based on high HIV burden, available country resources, and host government and civil society commitment to fighting the HIV epidemic. Ethiopia is one of those countries. USG agencies operating in Ethiopia have formed an Interagency Working Group (E-IWG) to plan, implement, and monitor the Emergency Plan program in Ethiopia. Active members of the E-IWG include representatives of the DOS, USAID, the DOD, and HHS, as represented in Ethiopia by the U.S. Centers for Disease Control and Prevention (CDC). The E-IWG is in the process of developing a five-year Country Strategy, scheduled for completion by September 2004. The Emergency Plan Country Strategy will outline the roles and responsibilities of the various partners in achieving targets by 2009. Table 1 provides the targets the E-IWG has established for Ethiopia:
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Figure 2. Emergency Plan: Ethiopia Targets for 2004-2009 Target Area Total # Infections averted Infections averted PMTCT Infections averted Other Total # Receiving Care & Support Care and Support: OVC Care and Support: Palliative Care and Support: Non-ART care Care and Support: ART 2004 61,500 2005 144,000 2006 251,000 2007 377,000 2008 552,000 2009 682,000
3,500
10,000
19,000
30,000
44,000
60,000
58,000
134,000
232,000
347,000
508,000
622,000
92,000
213,000
358,000
608,000
1,050,000
10,000
84,000
153,000
276,000
500,000
32,000
61,000
114,000
211,000
388,000
50,000
68,000
91,000
121,000
162,000
15,000
30,000
57,000
109,000
210,000
Notes: The “infections averted” data are modeled under the GOALS Model of USAID’s Policy Project. PMTCT coverage is limited to 12% of pregnant women by 2008. This is double the current 6% of births that have assisted deliveries. This results in a total of 37,000 infections averted through 2010. We also assume that the family planning program expands under the community worker program financed largely by USAID so that contraceptive prevalence increases from 8% in 2000 to 20% by 2010. This increased use of FP averts a total of 39,000 births that would have been HIV+. The PMTCT infections averted in this table include those infections averted by PMTCT and those HIV+ births averted by family planning.
Emergency Plan funding to achieve these ambitious targets is subject to annual allocations by the U.S. Congress and the Department of State, and outside of USAID’s normal planning and budgeting process. Overall country planning is undertaken jointly by the E-IWG. The current year Ethiopia Emergency Plan Country Strategy is driven by the overarching target of providing ART to 15,000 PLWA by 31 March 2005, and significantly higher levels in subsequent years. The Emergency Plan strategy initially foresees providing ART through 25 hospitals countrywide, with expansion in out-years. The hospitals are in large part situated
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in areas with known high levels of HIV, where other donors/partners are not already providing similar support. With the exception of ARV logistics and management, which will be provided on a national level through the USAID activity Rational Pharmaceutical Management – plus (RPM-plus), much of the direct USG Emergency Plan assistance to these hospitals will be provided through CDC. In order to provide a “feeder population” for ART at the target hospitals, the Emergency Plan envisions support to a network of approximately 220-250 health clinics countrywide, or an average of 10 for each of the hospitals. An increasing number of these clinics will provide Voluntary Counseling and Testing (VCT) to a broad population segment (and all will provide referrals for VCT). Clients who are found to be HIV-positive will be referred to the hospitals for evaluation and possible ART. Over time, an increasing number of the clinics will also provide Prevention of Mother-to-Child-Transmission (PMTCT) counseling and therapies as part of ante-natal care programs. Most of the USG Emergency Plan assistance to these health clinics will be provided through USAID. 2. Background Ethiopia
Country Setting Ethiopia is a federal republic organized into ethnically similar regions. Already composed of 70.7 million people, Ethiopia is experiencing rapid population growth adding approximately 1.4 million people annually. Fifteen percent of the population is urbanized but regional centers are quickly expanding and full accounting of growth is difficult. The capital, Addis Ababa, retains the majority of the formal business community. There are nine ethnically-based regions and two special administrative areas (Addis Ababa and Dire Dawa). In the decade since, issues have arisen that may as much be a result of uneven allocation of development resources and poor capacity as they are the result of ethnicity and ethnic rivalries. Religion plays a major part in the lives of most Ethiopians and religious networks reach even the most remote parts of the country although unlike elsewhere in Africa there is not a strong tradition of religious health care or education facilities. The major religions in Ethiopia are Orthodox Christianity (50%), Islam (34%), Other Christianity (11%) and Animism (5%).1 Unlike many countries in the world, to date there is remarkable religious tolerance and harmony. As with much of the rest of the continent, the population of Ethiopia is very young with 44% of the population under the age of 15 and an additional 20% in the age group 15 – 24. At current rates of growth, the population will double in less than 30 years. Despite a population policy since 1993, the annual growth rate is 2.7% and the fertility rate is 5.9. Maternal mortality rates are 871 per 100,000 live births, under-five mortality rates are 188 per 1000 and life expectancy is 45.7 years, with HIV/AIDS reducing projected gains in life expectancy. Half of Ethiopia’s children are underweight for their age and over half are stunted. The primary school gross enrollment rate has increased to 65% (40% girls), at the expense of the quality of education, which has dropped in recent years. The adult literacy rate is 32.8% (26.4% females; 39.3% males). Basic living conditions in terms of health, sanitation and nutrition are extremely poor for the majority of the population. Current figures indicate that GDP has fallen to $91 per capita in the past 10 years, making Ethiopia one of the poorest countries on the continent. Gross per capita incomes are five times less than the African average with a decline of 40% from 1990 to 2000 compared to a smaller decline of 13% for sub-Saharan Africa. A nascent private sector shows strong potential but to date had been supplied with few incentives to succeed. 1 Note, the breakdown by religion is a sensitive issue and not all sources agree. 3
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While the Ethiopian Constitution guarantees gender equity, cultural and religious laws discriminate against women and the majority of women (and men) are unaware of their rights under the Constitution or of avenues through which to pursue them. The UNDP has ranked Ethiopia 139 out of 144 countries in terms of the status, treatment and participation of women. Socially, women are subordinated; cultural and religious customs support male over female rights and gender and sexual violence are widely accepted. Women have been socialized to accept cultural norms that disadvantage them. For instance, 85% of women believe that a man is justified in beating his wife; early marriage and abduction of girls is common while 80% of all women have undergone genital cutting. All three forms of female cutting are practiced in Ethiopia with the most severe leading to major health complications and death. Violence against women is a major issue in Ethiopia including rape and wife abuse and belies the low status of females. Tuberculosis in Ethiopia Ethiopia ranks eighth among 22 countries worldwide with high-burden TB incidence. According to the Global TB Control WHO Report 2004, there were an estimated 262,000 cases in Ethiopia, with an estimated incidence rate of 370 per 100,000 people, in 2004. The TB and Leprosy Control Program (TLCP) began DOTS implementation in 2 zones in 1991. Case notification rates have increased rapidly since 1995, at about 16% per year both for smear-positive cases (SS+) and all forms of TB. These increases can be attributed both to the rapid expansion of DOTS, improved case finding under DOTS and to the increasing pace of spread of HIV. Notification rates are highest among young adults, and an estimated 29% of adult TB patients are HIV-positive. Treatment success rate for the 2001 cohort was 76%; 7% of patients died during treatment; 6% defaulted; and 7% were not evaluated. Both case detection and cure rates faltered over the last one year as a result of weakness in program management, at federal and regional levels. Of the 70 zones in the country, 64 (91%) are currently implementing DOTS. Of the 605 woredas (districts) in the country, 522 (86%) have at least one health facility providing DOTS. Of the 2,552 government and NGO-run health facilities in Ethiopia, half are implementing DOTS. HIV/AIDS in Ethiopia The HIV/AIDS epidemic in Ethiopia is serious and at a crucial juncture. UNAIDS and the Ethiopian government have recently revised HIV/AIDS prevalence information for Ethiopia and report 1.5 million people living with HIV and AIDS and an adult prevalence of 4.4 percent.2 The Ministry of Health (MoH) now recognizes HIV/AIDS as one of the leading causes of adult morbidity and mortality in Ethiopia. UNAIDS reports that of the 1.5 million HIV/AIDS cases, women account for 770,000 thousand, children for 120,000 and men for over 610,000.2 Approximately 4,500 of the 1.5 million people were on antiretroviral therapy (ART) as of early 2004. Non-ART care, including improving nutrition, providing psychosocial counseling, treatment of opportunistic infections (OI), and in general helping infected persons live positively, is limited in scope due to pervasive stigma and the lack of indigenous capacity for such care. In 2003, the number of children orphaned by AIDS was estimated at 700,000 and this figure is projected to rise significantly in the coming years.
2 Significant efforts to improve surveillance have led to the most recent revision to 4.4 percent. In 2002, estimates of national prevalence for HIV/AIDS were reduced from the 2001 figure of 7.3 percent to 6.6 percent. This was NOT attributed to successful programming but was due to the reclassification of one of the surveillance sites from rural to urban.
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Surveillance data from 2001 (available in “HIV/AIDS in Ethiopia, 4th Edition) suggest that concentrations of HIV infections are found in urban centers. National urban adult prevalence is 13.7 percent. This figure disguises regional variations. Bahir Dar, in Northwestern Ethiopia, has the highest prevalence at 23.4 percent. Prevalence in Addis Ababa is estimated as 15.6 percent. The rural prevalence of HIV and AIDS is apparently much lower at 3.7 percent. There is real concern regarding the accuracy of the 2001 HIV/AIDS data, particularly with the extremely limited surveillance in rural areas. Of the 34 surveillance sites, only six covered a rural population of almost 59 million. Anecdotal evidence suggests that HIV prevalence in some rural areas may be as high as 10 percent. Information on groups at risk of infection in Ethiopia is scanty, but believed to be the same as in most other countries. These include mobile men, commercial sex workers, men with disposable incomes, internally displaced persons (IDPs) and refugees, youth – particularly females – and the military. New data from expanded surveillance, VCT sites, and surveys should provide more information in future years. Gender inequalities are of major concern in Ethiopia. Well documented are the inequalities in access to food, education, health care and employment opportunities and the lack of economic and social power of women. Less well documented is the extent of sexual and domestic violence against women. Gender is a major constraint in terms of combating HIV/AIDS. Women have limited social, cultural and economic power to refuse sex, choose a sexual partner or negotiate condom use. Government of Ethiopia Response to the HIV/AIDS In the 1990s, the HIV/AIDS policy and programming environment in Ethiopia was very weak given the concentration on rebuilding the country following years of civil war. Since 1998, however, there has been a renewal of Government attention to HIV/AIDS. 1998 2000 2000 2001 2002 HIV/AIDS Policy published. National AIDS Council and National AIDS Council Secretariat established. Publication of four-year federal and regional multi-sectoral HIV/AIDS plans. Publication of the Strategic Framework for the National Response to HIV/AIDS in Ethiopia (2001 – 2005). Legal constitution of the national and regional AIDS secretariats; bodies renamed HIV/AIDS Prevention and Control Offices (HAPCOs). HIV/AIDS considerations integrated into the Sustainable Development and Poverty Reduction Program (SDPRP) and the Health Sector Development Program II (HSDP II, 2002). Publication of National Guidelines for PMTCT in Ethiopia, National Guidelines for VCT in Ethiopia and the Policy on Antiretroviral Drugs, Supply and Use Of. National Partnership Forum established by HAPCO to act as a representational body of key stakeholders in Ethiopia for HIV/AIDS programming. Publication of Guidelines for Use of Antiretroviral Drugs in Ethiopia and the National Implementation Framework for PMTCT in Ethiopia.
2003
The current response to HIV/AIDS is shaped by the National AIDS Council’s Strategic Framework for the National Response to HIV/AIDS in Ethiopia (2001–2005). The framework identified Information-Education-Communication/Behavior Change Communications (IEC/BCC); Condom Promotion and Distribution; Voluntary Counseling and Testing (VCT); Management of sexually transmitted infections (STIs); Blood Safety; Universal Precautions;
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Prevention of Mother-to-Child-Transmission (PMTCT); Care and Support; Legislation and Human Rights and Surveillance and Research as the 10 priority intervention areas. In 2001, Ethiopia secured a loan from the World Bank, amounting to US$63.1 million over a three-year period to largely fund the Ethiopia Multi-Sectoral AIDS Program (EMSAP). The funding from the World Bank addresses four key areas: capacity building for Government agencies and civil society organizations; expanding the Government’s multi-sectoral response and providing an Emergency AIDS Fund to develop programs at the district level. This funding line was due to finish in 2004, but due in most part to slow disbursements, the funding has been extended for a further year. More information on EMSAP can be found at www.worldbank.org, Ethiopia Projects. Reviews of Ethiopia’s HIV/AIDS program have identified limited institutional capacities and programmatic responses at all levels. Weaknesses include limited absorptive capacity of Government and non-government organizations, low level of fund disbursement, lack of coordination, limited technical support available to civil society organizations and lack of programming, appraisal and monitoring and evaluation skills within the national and regional HAPCOs. The delineation of roles and responsibilities between the HAPCOs and the Ministry of Health and the regional bureaus is unclear and coordination and collaboration are weak. Wider inter-sectoral communication and collaboration is also considered to be poor. In response to these findings, HAPCO is revising the Strategic Framework for the National Response to HIV/AIDS (2001–2005). Drafts indicate that capacity building (of civil society organizations at the woreda level and of institutional and organizational capacities) and mainstreaming have been added as priority intervention areas. ARVs and TB are also given greater emphasis. The need to work at the woreda level and to involve a broader range of partners receives much more attention and there is also a consideration of the possibility of combining targeted activities with broad-based programs. Despite the relative proliferation of HIV/AIDS policies, programs and sector plans, the commitment of national and regional government to engage in HIV/AIDS is questionable. The quality of action plans has been criticized, policies are not widely enforced and implementation of sectoral plans and the Strategic Framework has been limited. A recent survey by the Ministry of Labor and Social Affairs (MOLSA) found that one out of five government officials interviewed were unaware of the existence of a national HIV/AIDS policy, one out of ten did not believe that the policy had any relevance to them and one out of four government offices had no plans for implementing the policy. More extensive information on AIDS in Ethiopia is available in the USAID/Ethiopia HIV/AIDS Strategy 2003-2008 available at www.usaid.gov, as well as numerous other documents accessed through www.dec.org. Ethiopia Private Sector and Response to the HIV/AIDS Private investments (domestic and foreign) in manufacturing, agriculture, agro-business and mining, constitute about 10 percent of the GDP (up from about 7 percent in 1994). Approximately 85 percent of the economy is informal. Ethiopia is a transition economy, with many sectors still heavily influenced by the state, fragmented or dominated by the informal economy. Major constraints to growth include high taxation, scarcity of human skills, limited access to land and to finance, government bureaucracy, weak infrastructure and an uneven playing field created by the operation of party affiliated companies. The Government of Ethiopia has recently started addressing some of the key obstacles to an improved investment climate, including removing regulatory and operational impediments to exports, fostering more competition in agricultural inputs and products markets, strengthening and
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liberalizing the financial sector, and reforming public service delivery, tax structures and foreign investment proclamations. Ethiopia depends on human capital for development, yet the ILO forecasts HIV/AIDS will decrease the labor force of the country by 10.5 percent by the year 2020. The professional classes in Ethiopia are vulnerable because adult HIV prevalence rates already are much higher and relatively fewer professionals are concentrated in a smaller number of key positions and geographical areas. Poorly developed labor markets, low levels of savings and investment, inadequate standards of governance and low educational standards are some factors that magnify the impact of the country’s ill health. Ethiopia’s private sector can be broken into distinct categories: Informal and Micro; Small and medium enterprises; Large and multi-national enterprises; and Autonomous parastatal organizations operating under favorable market conditions.
Typically, large and multi-national enterprises and parastatal organizations have existing workplace programs of varied capacity. Multi-nationals can draw from a knowledge based response and corporate program. Some parastatal programs have accessed resources from public sources to initiate HIV activities. Informal, micro, small or medium enterprises representing the majority of private sector organizations have limited capacity in initiating or sustaining workplace programs. Typically, sensitization, prevention and care and support activities are directed from anti-aids committees, or driven by a few committed employees, employers and community members. Few workplace programs in any category are providing treatment (with nutrition, non-ART or ART components) or palliative care in the home or community. OVC planning has not been a consideration for the majority of private programs. Activities from cross-business associations have completed sensitization campaigns and very limited activities in other areas. Some model enterprises benefited from assistance of cross-business programs (EEF, AACC) and have now outpaced the programs Enterprises who previously began workplace programs with the assistance of the Ethiopian Employers Federation and Addis Ababa Chamber of Commerce have outpaced the products and services of these organizations and are implementing limited BCC activities, VCT, OVC, treatment, care & support and financing options at the facility and community level. Recent activities to establish an Ethiopian Business Coalition on HIV/AIDS could consolidate activities and appears to be a logical focal point as the organization’s programmatic features mature. In terms of private health care providers, in 2002, private clinics accounted for about 22% of all health facilities in Ethiopia (1235 out of 5410 total, excluding private pharmacies), with the vast majority of them found in Oromia (435), Addis Ababa (340), and Amhara (206). Additionally, there were 12 private hospitals, of which 10 were in Addis Ababa and 2 were in Tigray. Of the private clinics, 462 were considered “lower” (very small dispensaries), 189 were “medium” (primary care, generally headed by a nurse), 88 were “higher” (broad primary and urgent care, generally headed by a doctor), and 61 were special.
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U.S. Mission Response to HIV/AIDS to Date The involvement of the USG in HIV/AIDS programming began in 1992 with the condom social marketing program. Programming remained relatively small-scale until 1998. For example, a 2000 review of the USG’s HIV/AIDS program, prepared for USAID’s FY 20012006 Integrated Strategic Plan highlighted the following achievements: an improved policy environment, modest improvement in availability and quality of treatment services available for sexually transmitted infections (STIs) and HIV/AIDS, and significant increase in social marketing of condoms, far exceeding targets. Since 2000, the USG has increased its HIV/AIDS activities in selected urban and peri-urban areas around the country, covering approximately four million people. Major government partners are the national and regional HAPCOs, the Ministry of Health, regional bureaus, the Ministry of Youth, Sports and Culture and the Ministry of Labor and Social Affairs. The USG’s HIV/AIDS programs are implemented through a range of international cooperating agencies and private voluntary organizations that partner with government offices, local nongovernmental, community and faith-based organizations. The USG is implementing its current HIV/AIDS program not only through its partners working in the health, population, and nutrition arena, but also through partners working in other sectors. HIV/AIDS is being addressed in USG-funded programs improving complementary teaching and learning materials for primary schools, through small-scale agribusiness and microenterprise development activities, as part of development and emergency distribution of P.L. 480 food aid, in refugee assistance programs, in basic NGO strengthening activities, and in training programs for the uniformed services. As of FY 2003, the USG supported HIV/AIDS activities in all urban and peri-urban areas nationwide, covering approximately 4 million people exclusive of national-level social marketing. During FY 2003, USAID and CDC collaborated with all stakeholders on development of Ethiopia’s National Implementation Framework for PMTCT as part of the President’s Special Initiative. Implementing partners conducted workshops and planning sessions with partners in high prevalence areas in preparation for roll-out in FY 2004. USAID support to VCT expanded to 36 sites with 7,706 clients. New behavior change communication campaigns planned during FY 2003 are expected to greatly increase client coverage in FY 2004. USG-assisted care and support of orphans and other vulnerable children affected by HIV and AIDS increased significantly, from 550 in FY 2002 to 11,506 in FY 2003. The collaboration between the USG’s HIV/AIDS and P.L. 480 Title II food aid partners greatly facilitated this increase. By contrast, USAID-assisted care and support to PLWA reached only 29,064, short of a 50,000 target. The shortfall is primarily attributable to significant resources and attention drawn away to support famine victims instead. The USG continued to work on risk reduction strategies, in collaboration with local FBOs and CBOs. In FY 2003, five FBOs covering about 14 million Orthodox, Protestant, and Muslim adherents undertook community education, training, and other interventions promoting the ABC philosophy (Abstinence, Being faithful, and correct and consistent use of Condoms).
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Although the USG has worked extensively with private non-governmental organizations (NGOs), its collaboration with the Ethiopian for-profit private sector to combat HIV/AIDS has been more limited: The U.S. Mission has supported condom social marketing in Ethiopia for over a decade, with Population Services International (PSI) and its local partner, DKT Ethiopia. STI management has been covered through USAID’s family planning/reproductive health program with Pathfinder International, but the success of the program has been severely impacted by the difficulties in provision of the necessary drugs. Ensuring condoms for high risk behavior can be a problem; if not the commodities, then the resources to support distribution. The Global Fund does not currently set aside money to purchase condoms. The USG ceased provision of operating costs for social marketing at the end of September 2003, although it is providing 60 million condoms each in FY 2004 and 2005 for social marketing. The United Kingdom is supporting the launch of a second socially marketed condom in late FY 2004. Given the relatively small supply in comparison with major demand, there is a need to improve focus of social marketing of key products (condoms, STI drugs) for high risk groups. Pathfinder International, under USAID’s Family Planning/Reproductive Health (FP/RH) program, has managed a workplace-based program for HIV/AIDS prevention IEC with several large companies. On the side of labor, Pathfinder collaborated extensively with the Confederation of Ethiopian Trade Unions (CETU) to establish workplace policies at the Metahara and Wonji Sugar Estates in 2001. Since that time, the program has grown to include two textile factories, one oil/flour factory, and three hotels. Pathfinder has also used management as an entry point, and in 2003 worked with 12 Chambers of Commerce around the country to expose members to the potential benefits of workplace policies. In 2003, working with CETU and/or management, Pathfinder initiated 6 workplace programs in the Bahir Dar urban area, which has a prevalence rate of 23%. These and 7 other programs around the country cover thousands of works. Activities in addition to workplace policy development include training peer promoters and establishing condom distribution systems. USAID’s Policy II Project implemented by The Futures Group has complemented the work of Pathfinder with CETU, and in FY 2003 helped CETU draft a “Workplace HIV/AIDS Policy Guidelines of CETU” which was presented at a Tripartite workshop on the Draft National HIV/AIDS Workplace Strategy and ILO Code of Practice on HIV/AIDS” organized by the ILO in November 2003. Pathfinder has also worked with private health providers to improve the quality and provision of FP/RH services through establishment of a Private Sector Franchise Initiative (Biruh Tesfa Health Network). Biruh Tesfa is implemented in sixteen woredas in five zones covering over 100 for-profit clinics. Pathfinder is assisting them to provide quality RH services that include family planning, antenatal care, delivery, postnatal care, and childcare for those clients who can afford and prefer to go to the clinics as an alternative to public health services.
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Under the Essential Health Services in Ethiopia II (ESHE II), Abt Associates Inc. (a subcontractor to John Snow, Inc., or JSI, under ESHE II) is also addressing private sector involvement in health care. In 2003-2004, Abt convened key stakeholders to revise Federal Ministry of Health guidelines formalizing the extent of private sector involvement in health care service delivery and financing thereby improving the conditions for an enabling environment. Abt is approaching the private sector through sub-sectoral groupings: Medical practitioners, pharmaceutical importers, pharmaceutical enterprises (domestic), and medical retailers. Abt has also provided limited technical assistance to the Addis Ababa Chamber of Commerce and the Medical Association for Professional of Private Practitioners (MAPPP) established in early 2004. On-going activities include technical assistance to assist professional associations advocate for an enabling policy environment continue with targeted interventions in the MAPPP through support for training and advocacy initiatives. In FY 2004, the USG initiated implementation of NetMark in Ethiopia, implemented by the Academy for Educational Development (AED). NetMark plans to work with commercial distribution networks to increase the supply of and access to insecticide treated bednets to key populations nationally, using a targeted subsidy system. The USG is also beginning support to a new initiative with Development Alternatives, Inc., which will work with private sector partners to procure and distribute drip irrigation systems appropriate to the needs of HIV/AIDS-affected households, especially those that are women headed. The activity is due to start in 4th quarter FY 2004. It is hoped that activities such as these will engage a broader segment of the private sector than has previously been reached in addressing the epidemic.
A Private Sector Advisor sitting at USAID’s Health, AIDS, Population, and Nutrition (HAPN) Office provides ongoing technical to private sector activities in HIV/AIDS. The Advisor is currently providing ad hoc and coordinated technical assistance to large and multi-national companies, the insurance and financial services sector, professional medical associations and representative bodies of the private sector who have expressed an interest in expanding their response to include treatment and care & support components in the workplace, communities of operation and client base.
USAID Response to Tuberculosis to Date USAID support to the Ethiopian Tuberculosis and Leprosy Control Program began in 2001 with the goal of strengthening the program. In consultation with experts at the TB and Leprosy Diseases Prevention and Control Team, under Disease Prevention and Control Department of the Federal Ministry of Health, USAID has developed a strategy to strengthen 3 Regional Referral Laboratories in Oromia, Amhara and Southern Regions and 8 selected Zonal Laboratories within the regions. Between 2001 and 2003, USAID has allocated approximately $1M for interventions to strengthen laboratories.
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3.
PERFORMANCE BASED SCOPE OF WORK Objective
As stated in the introduction, the Contractor shall provide technical services that will expand knowledge of and access to affordable and quality HIV/AIDS and TB oriented health care packages delivered by the private sector to mass markets of moderate and low income individuals and workplaces, with specific emphasis on three key strategies: i) fostering private sector partnerships to address HIV/AIDS and Tuberculosis; ii) promoting social franchising to improve quality of private sector care in HIV/AIDS and Tuberculosis; and iii) highly targeted social marketing of HIV/AIDS prevention products and services to high risk groups. The technical services required are expected to include but not be necessarily limited to: short- and long-term technical assistance (TA); support to/provision of non-academic incountry and third-country workshops and conferences, targeted evaluations refining identification of high risk groups and programming entry points, performance improvement plans and observation tours; development and dissemination of information on best practices related to private sector approaches to HIV/AIDS and Tuberculosis, and other communications; harmonization of data collected by USG partners for USG reporting requirements; subject to the availability of resources, administration and management of modest “simplified grants under contracts” to complement civil society and private sector initiatives in addressing HIV/AIDS and Tuberculosis; and collaboration with all USG partners engaged in the Emergency Plan and private health care activities. It is emphasized that the Emergency Plan for AIDS Relief is a rapidly evolving initiative, and ultimate levels accorded to Ethiopia are subject to U.S. Presidential, Congressional, and Department of State decisions and appropriations on an annual basis. It is possible that funding levels may vary by total and/or on a year-on-year basis, requiring some adjustment of the Contractor’s Annual Workplans and targets. The USG will collaborate closely with the Contractor as Emergency Plan funding and guidelines evolve to assure necessary degrees of flexibility are built into all Workplans and strategies over the course of the Task Order. Program Coverage The Contractor is expected to provide products or services in highly affected urban, periurban areas and institutional settings (i.e. large industrial and agricultural settings) located throughout Ethiopia. The Contractor should include a comprehensive outline of sequencing and staging activities to have both an immediate contribution to the Emergency Plan targets alongside rapid scaleup to contribute to targets in out years. Cross-Cutting Themes The Contractor shall incorporate the four cross-cutting themes of gender, stigma, and community and the greater involvement of people living with HIV/AIDS (GIPA) in all of its program planning, achieving, monitoring and evaluation
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Program Components There are three major components that correspond to the three key strategies to be pursued: i) fostering private sector partnerships to address HIV/AIDS and Tuberculosis; ii) promoting social franchising to improve quality of private sector care in HIV/AIDS and Tuberculosis; and iii) targeted social marketing of products and services to high risk groups. In order to help the Contractor understand USG priorities for this program, the discussion below provides an indicative relative level of effort (LOE) for each of the components. The Contractor is expected to propose interventions and management of resources that correspond to the LOE indicated. 3.4.1 Component #1: Private Sector Partnerships (70% LOE). The Contractor shall build upon work undertaken by the USG and other partners to date and shall identify key groups/coalitions of private sector actors – both private health care providers, and non-health care private commercial companies – which provide a viable entry point to reach large numbers of clients/workers in prevention, care and treatment. The Contractor shall work with private providers, pharmacists and drug wholesalers (“depot holders”), and various business coalitions and large industry to improve access to, quality of, and consistency of private health services for treatment. Some of the organizations are promoting quality assurance standards that the Contractor could help promote, and/or the Contractor could help develop such standards for different services. Private pharmacists have shown they are willing to be more involved in provision of key services, and could become even more useful in outreach in especially critical areas, e.g. STI syndromic treatment. Several large employers are exploring how to expand their workplace clinics – essentially small managed care facilities – to meet the needs of HIV/AIDS and Tuberculosis, including ART. Many employers are also increasingly interested in extending managed care to families and communities of operation. Illustrative activities could include but are not limited to: Establishment of a DOTS-like activity at workplaces, informal settings (i.e. Markets) and in communities of operation for TB and ART (when possible). Catalyze partnerships (GDAs) with new partners to the USG and encourage costsharing arrangements with the private sector to increase access to HIV/AIDS prevention, for-fee performance improvement in responding to HIV/AIDS and Tuberculosis to professionals, and increasing access to treatment of STIs, OIs and Tuberculosis with a progression to ART when the policy environment allows. Technical assistance to representative and cross business organizations (i.e. Employers Federations, Trade Unions, Market Associations, Alliances or other NGOs addressing HIV/AIDS and Tuberculosis in the workplace and communities of operation). Technical assistance to professional associations to promote quality assurance of services provided (i.e. treatment, laboratory services, performance improvement). Technical assistance to private medical providers and the insurance sector on the function and implementation of medical prepayment schemes, risk pooling and health insurance products.
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Capacity building of enterprise-level facilities with clinical care environments to provide managed care for employees, dependents and communities of operation. Technical assistance to local professional associations to increase the diversity and scale of local production capacity regarding various products and services (i.e. pharmaceutical and medical supplies and administration, logistics and knowledge management services). Subject to availability of funds provision of modest matching grants, as “grants under contracts”, to civil society and representative business organizations to promote innovative workplace programs and build sustainability of programs through local ownership.
3.4.3 Component #2: Social Marketing to High Risk Groups (20% LOE). The Contractor shall undertake low-cost social marketing of generic products to prevent new HIV infections in high risk groups. There is no perceived need for new products at this time: DKT sold about 54 million Hiwot Trust condoms last year and USAID plans to continue providing 60 million/year to DKT under the Hiwot Trust label for at least the next two years. DfID is about to launch an up-market “Sensations” condoms through DKT and other outlets. DKT also sells oral contraceptives and Depo-Provera with other donor assistance, as well as oral rehydration salts. The Contractor shall collaborate with in-country social marketing agents (e.g. DKT) and private sector organizations with technical capacity in marketing to deepen penetration to high risk groups. This would include improved market segmentation evaluations and BCC to high risk groups not addressed by other programs. The USG references 2004 Emergency Plan targets to avert new HIV infections. Illustrative activities would include, but not be limited to: Collaboration with DKT and other providers of key HIV/AIDS prevention products in devising strategies to improve depth of coverage of high risk groups. Exploring synergies with business and professional associations, large employers and their communities of operations to market and distribute products. Advanced market segmentation evaluations of high risk groups. Provision of generic social marketing of condoms and other HIV/AIDS prevention mechanisms to high risk groups.
3.4.2 Component #3: Social Franchising of health facilities, pharmacies and laboratories (private and public) (10% LOE). As mentioned above, Pathfinder International has introduced the concept of “social franchising” for FP/RH through the “Biruh Tesfa” network. Other partners (Government, private, international) have promoted different concepts of franchising in selected areas. The Contractor shall explore options for social franchising for private providers in HIV/AIDS and Tuberculosis care and treatment both in combination with other services (primary care, FP/RH, etc) and as a “stand alone” HIV/AIDS franchise, and shall present analysis of options and recommendations for private provider groups to consider. Resources permitting, the Contractor shall assist private provider groups in implementing the options chosen. The USG is exploring the feasibility of social franchising of HIV/AIDS services. Based on targeted evaluations of the initial year of activities by the Contractor, the USG would consider increasing the LOE of this component.
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Illustrative activities include, but are not limited to: Studies/assessments of prior social franchising efforts in Ethiopia, with analysis of “best practices” and cost and other implications. Exposure to “best practices” in social franchising from Ethiopia and elsewhere for public and private stakeholders, through workshops, study tours, etc. Support to a private alliance/coalition-led franchising for different health facilities (private or public) or services. Areas of early interest are ANC/PMTCT, VCT and ART facilities. Support to a social marketing campaign using low-cost mass media in urban and periurban areas creating demand for existing or new franchises.
4. Program Management 4.1 Core Office The Contractor shall establish a modest office in Ethiopia to provide necessary support for management and technical assistance activities under the Task Order. The core office will provide all administrative and management support to the Contractor under the program, including implementation of financial and accounting systems for commodity procurement, arranging for and supporting in-country training, processing of short-term consultants, provision of all travel and support for long- and short-term personnel, etc. It will operate under the general supervision of the Chief of Party/Project Director. In addition to the long-term TA positions necessary to achievement of Task Order deliverables, the Contractor is expected to maintain adequate technical and support staff for the core office. 4.2 Headquarters Supervision and Support Any direct level of effort attributable to headquarters activities is expected to be focused primarily on that required for sourcing information, technical expertise, and the information technology hardware and software to support the field team. 4.3 Roles and Relationships 4.3.1 Relationships with USAID/Ethiopia The Contractor shall be responsible for ensuring achievement of all Tasks and for all products and reports required under this Task Order. The Chief of Party shall be authorized to represent the Contractor in all matters pertaining to the execution of the Statement of Work, with the exception of Task Order amendments. The Chief of Party will serve as the Contractor Representative in Ethiopia for the purposes of this Task Order, and will be responsible for the activities of all long- and short-term personnel under the Task Order. The Chief of Party shall receive technical direction from the USAID Cognizant Technical Officer (CTO) or the Contracting Officer (CO), only.
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4.3.2 Relationships with Implementing Agencies The Contractor shall work closely with the key Ethiopian and international partners of USAID to assure that all activities are collaboratively programmed. USAID intends that coordination and decision making regarding ongoing implementation of the project will be assured through an informal consultative process that will involve customers, partners and other stakeholders on an on-going, topic-driven basis. Key stakeholders are expected to include but not be limited to: HIV/AIDS Prevention and Control Office (Regional and Federal) Ethiopian Insurance Association Medical Association of Private Professional Practitioners (MAPPP) Confederation of Ethiopian Trade Unions DKT Ethiopia Pathfinder International
The Contractor will collaborate closely with USAID to establish processes and/or systems for broad-based customer consultation and input as the program progresses, to assure that USAID maintains its core values of customer service and participation throughout the life-ofplan. 4.3.3 Logistic Support The Contractor shall be responsible for all logistical support except: - Duty free entry for Contractor professional commodities and informatics commodities purchased with USAID funds under the activity; customs clearance (with the exception of customs exemption letters provided by USAID) shall be the responsibility of the Contractor; - Long-term residence visas for long-term technical advisors and their dependents; Any other possible Mission support or Contractor access to Mission services will be determined by Mission policy in existence during any given time during the life of the Task Order. 4.4 Designation of Key Positions and Personnel The Chief of Party/Country Representative shall be authorized to represent the recipient in all matters pertaining to the execution of the Program Description with the possible exception of CA amendments, for which authority shall be delegated at the discretion of the Contractor. The Chief of Party/Country Representative will serve as the Contractor's Representative in Ethiopia for the purposes of the CA. The Chief of Party/Country Representative shall receive technical guidance from the USAID Cognizant Technical Officer (CTO) or the Contracting Officer (CO), only.
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4.5 Performance Measures The Contractor must provide comprehensive monitoring, evaluating, and reporting (MER) on achievements and impact throughout the period of the agreement. Specific data required are of two types: i) those that report on progress toward Contractorproposed milestones and targets under the Task Order; and ii) those to measure the Emergency Plan HIV/AIDS indicators. The first type of data should include reporting on the Contractor’s contribution toward a selected number of milestones and targets toward which the Contractor is working. Those milestones chosen by the Contractor to gauge its progress, and establishment of timing and/or coverage targets related to each, shall be established by the Contractor during negotiation of the Task Order with USAID. They shall be reported on in quarterly reports. The second set of data would include reporting against the Emergency Plan HIV/AIDS indicators. Preliminary indicators are provided below. These will be refined as the Emergency Plan Monitoring Plan is rolled out, and will be communicated to the Contractor. The Contractor shall provide USAID the requisite data for Emergency Plan reporting as required by Emergency Plan, currently anticipated as every six months, as part of its quarterly reporting requirements. (That is, every other quarterly report would also include reporting on Emergency Plan indicators for the preceding 6 months period). Program performance measures for Emergency Plan-supported programs are established in “The President’s Emergency Plan for AIDS Relief Indicators, Reporting Requirements, and Guidelines, “produced by S/GAC and dated April 14, 2004. For “Prevention” these are: Behavior Change: Community Outreach Note: “community” can be defined as “workplace” Number of programs providing community (workplace) outreach HIV behavior change services. Number of programs providing community (workplace) outreach HIV behavior change services that include an abstinence and faithfulness message. (subset) Number of individuals served by programs providing community (workplace) outreach HIV behavior change services, disaggregated by sex. Number of individuals served by programs providing community (workplace) outreach HIV behavior change services, disaggregated by sex. Number of persons trained to provide community (workplace) outreach HIV behavior change services.
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8/19/2004 PSP TO Statement of Work
Behavior Change: Mass Media Note: “mass media” could include national and/or sub-national programs that involve radio and/or television addresses, and/or any other mass-scale dissemination of IEC and BCC messages to promote avoidance of or reduction of HIV risk behaviors, and the social marketing and/or promotion of condoms. This includes work with high-risk groups such as injecting drug users, men who have sex with men, commercial sex workers, and persons living with HIV and AIDS, ad well as activities (including training) to promote abstinence until marriage, delay of first sex, faithfulness, partner-reduction and related social and community norms. Number of programs providing mass media HIV behavior change services. Number of programs providing mass media HIV behavior change services that include an abstinence and faithfulness message. (subset) Number of programs providing mass media HIV behavior change services that include an abstinence only message. (subset) Number of individuals served (program coverage estimates) by programs providing mass media HIV behavior change services. Number of persons trained to provide mass media HIV behavior change services.
Depending on partners/activities selected, the Contractor might also report on other Emergency Plan training indicators, e.g. number of persons trained to provide STI management services might be appropriate if private pharmacists are engaged. The Contractor will be expected to undertake data collection and verification strategies that ensure reliability and accuracy of progress toward expected accomplishments. In all cases the Contractor is strongly encouraged to collaborate in monitoring efforts with other Emergency Plan colleagues, the GOE, and other donor/partner programs, to assure that monitoring and evaluation systems are as cost-effective as possible. The methodologies for collection and actual data collected under the Task Order may need to be harmonized for ease of aggregation for Emergency Plan's reporting needs. The Contractor is encouraged to work with USAID and its Emergency Plan Team colleagues, as necessary to USAID management and reporting, to assure all data it is collecting and providing use USAID’s harmonized systems. Such harmonized systems are essential if data collected by different partners in different districts/provinces is to be aggregated for USAID reporting purposes. The Contractor should be prepared for revisions in required core indicators and reporting requirements during the lifetime of the award. 4.6 Quarterly and Annual Reports The Contractor shall submit to USAID/Ethiopia ten (10) copies in English of the following reports. 4.6.1 Quarterly Progress Reports: Not later than two weeks following the close of each quarter, the Contractor will prepare and submit to USAID quarterly reports (in both paper and electronic format). This report will summarize progress in relation to agreed upon milestones contained in the Annual Workplan, and will specify any problems encountered and indicate resolutions or proposed corrective actions. For each action, the Contractor will designate responsible parties and establish a timeframe for completion. The report will list activities proposed for the next quarter, noting where they deviate from the approved Annual Plan.
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The Contractor will include in each quarterly report a list of any sub-agreement proposals requiring USAID approval. The Contractor will include a listing of all sub-agreements in force during the reporting quarter. Until all Contractor-procured commodities are received and installed, the quarterly report will include an update on the procurement plan. The update should inform on tenders in preparation, tenders out for bid, awards, shipment, carrier name, and expected arrival date of major commodities. As described above, it is currently expected that Emergency Plan reporting will be on a semi-annual basis. This means that in every other quarterly report, the Contractor would also need to include reporting on required Emergency Plan indicators. 4.6.2 Annual Reports: At the end of each year of the CA, the Contractor will submit an annual report covering activities of the previous year (in both paper and electronic format). These reports will provide a succinct presentation of Contractor achievement of Contractor results, milestones and targets in the previous year, with supporting discussion as warranted, including as necessary to explain any shortfalls. These reports will summarize progress, provide an analysis of impact based on activities completed or in progress, and suggest resolution of any outstanding issues. In addition, as part of the aggregate reporting for the Private Sector Program as a whole, the contractor shall provide an electronic copy of the annual report to the Task Order One contractor. The Contractor for this Task Order is also expected to participate in any PSPwide meetings or reporting that for which their involvement is authorized by the USAID/Ethiopia CTO and CO. 4.7 Consultant Reports The Contractor shall additionally provide USAID Ethiopia with five (5) paper copies and one electronic copy of the products -- studies, trip reports, materials developed -- of all short-term consultants under the contract within 30 days of completion of the consultancy. In general, reports shall be in English. Where a report or document is more appropriately developed in Amharic or a local language –e.g. a training manual for local leaders – USAID may at its option request an English-language abstract.
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8/19/2004 PSP TO Statement of Work
Instructions for Task Order Request for Proposal of the PC4: Public Private Partnerships Program Technical Proposal Composition One original and four copies of the technical proposal shall be provided in hard copy, with an electronic copy on CD or diskette in PDF or Word format. The technical proposal shall be limited to 20 pages (plus appendices as required), in 12 point font, on 8 1/2” by 11” paper with one inch margins, and should cover the following elements: Cross Cutting Themes The Offeror shall incorporate the four cross-cutting themes of gender, stigma, and community and the greater involvement of people living with HIV/AIDS (GIPA) in all of its program planning, achieving, monitoring and evaluation. It is considered essential for the Offeror to incorporate specific strategies in the proposal that include Gender: The Offeror shall undertake outreach to recruit women’s organizations (professional or community-level) into training sessions and workshops for participation in the overall activities. In addition, the Offeror shall take into account the roles of men and women in HIV/AIDS issues and their potential solutions in all program interventions and behavior change strategies. Following USAID and evolving Emergency Plan guidance, the Offeror will disaggregate service statistics by sex to ensure that women have access to services in proportion to their needs. Stigma: The Offeror shall undertake appropriate measures to decrease stigma and discrimination in all activities at facility, community and systems levels. As described in the USAID/Ethiopia HIV/AIDS Strategy of October 2003, stigma acts as a key deterrent in information and health seeking behavior among the population. Although levels of HIV/AIDS awareness are high, misinformation is widespread. Fear of social isolation, rejection or violence lead many to hid their serostatus and prevent many more from getting tested. The Offeror shall utilize facility- and community-based and low-cost media (e.g. posters, low-literate hand-outs, etc) approaches to decreasing stigma in areas in which it works. Community: The Offeror shall work with key stakeholders to strengthen the capacity of the community (i.e. a worksite and/or a facility’s community of operation) throughout the program period. Lack of capacity at the zonal and woreda levels, coupled with inadequate resources from the regions make it difficult for the government to adequately address many of the gender, stigma, access, and quality of care issues it has recognized. Given the ambitious plans of the National HIV/AIDS Strategy and the paucity of resources, communities (private providers, private companies, workers) may increasingly have to take on new roles if they are to assure the HIV/AIDS prevention, care, and support services necessary for future growth and development. Experience with HIV/AIDS programs throughout Africa demonstrates that community-focused approaches are not only effective but may be the most sustainable over the decades it is likely to take to eradicate AIDS. It is within the community itself that the components of the systems come together.
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Greater Involvement of People Living with HIV/AIDS: The Offeror shall work with key stakeholders to strengthen the capacity of PLWHA organizations to participate in key dialogue, assist PLWHA organizations to provide a menu of services to workplaces and communities to reduce stigma and increase demand for VCT, care and treatment, and disseminate accurate information on HIV/AIDS and Tuberculosis. The Offeror shall also consider engaging PLWHA organizations that demonstrate a capacity to provide IEC and Advocacy activities at a facility, community or systems level to assist in the implementation of this activity.
Content The USG E-IWG requests the Offeror to demonstrate how specific technical approaches proposed will contribute to the Emergency Plan targets highlighted in Section 1 of this Performance Based Scope of Work. The Offeror should discuss projected amounts of “clients served” in prevention, care and support, and treatment (non-ART) categories in the initial year. The USG will apply performance-based approaches to out-year funding allocations. The Offeror should build flexible systems for rapid scale up of services to accommodate significant funding increases upon successful contribution to the USG reaching Emergency Plan targets. Year One programming should emphasize: Establishing systems for rapid scale up during out-years; Completing targeted evaluations to identify high risk groups for social marketing and social franchising activities in out years; Implementing products and services for HIV/AIDS and Tuberculosis prevention, care and treatment activities. All elements noted above must produce a measurable contribution to the Emergency Plan targets of 2004. The Offeror is expected to work in collaboration with existing local organizations, parastatal organizations, trade unions, large and multi-national corporate employers, and the informal sector. Out year programming should emphasize: Rapid scale-up of the provision of products and services to avert new HIV infections to high risk groups (targeting shall be dependent on year one evaluations in consultation with the USG Mission); Mobilize sub-populations in the communities of operation of workplaces to provide care and support; Significantly scale up access to treatment (non-ART and ART) services for HIV and Tuberculosis; and Build models with professional associations to self-accredit for quality assurance of services to the mass market. Specific Notes The Offeror should include a comprehensive outline of sequencing and staging activities to have both an immediate contribution to the Emergency Plan targets alongside rapid scale-up to contribute to Emergency Plan targets in out years. The Offeror shall pay specific reference to Emergency Plan targets and propose their minimum level of contribution to each category in FY04 and FY05. It is not expected that first year activities will contribute to treatment (ART) targets. The Offeror is expected to provide information on possible out-year activities to contribute to Emergency Plan treatment targets (ART). The Offeror is instructed to provide an explicit statement of commitment to engage PLWHA persons and organizations throughout the activity in their proposal.
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The Offeror is expected to propose interventions and management of resources that correspond to the LOE indicated. The Offeror is encouraged to maintain a low budget and minimal administrative costs, and shall define in detail their proposed arrangements and staffing.
Organizational Capacity The Offeror should describe its organizational capacity to implement the statement of work described in this request for task order proposal. This discussion should include specific capacity in public private partners, social marketing and franchising to high risk groups, HIV/AIDS programming to the private sector (formal and informal), TB and relevant infectious disease programming to the private sector (formal and informal), proposed methods for rapid scale-up of HIV/AIDS and TB activities to increase access to products and services, experience for-fee HIV/AIDS and TB-related training and workshops. Corporate Headquarters Involvement The Offeror should include a discussion of proposed corporate headquarters supervision, support, and quality control efforts under the CA. Any direct level of effort attributable to headquarters activities is expected to be focused primarily on that required for sourcing information and technical expertise to support the field team. Personnel Based on: (A) an understanding of the issues/problems and the challenges and opportunities of increasing the prevalence of private sector activities in the national response to HIV/AIDS and increasing access to affordable private health services to a mass market of moderate and low income individuals in Ethiopia, with specific attention to the technical needs of private practitioners clinical care environments, systems strengthening, and community mobilization, and HIV/AIDS programming in general, and (B) the challenges of scaling up to meet the HIV/AIDS challenge, and the Emergency Plan -and Offeror -proposed targets to be accomplished on a specific time-line; the Offeror 's proposal must define technical qualifications and experience, and position descriptions for any key positions and personnel that they propose. The Offeror shall propose a Project Director with relevant HIV/AIDS and/or TB programming experience to ensure rapid start-up. The Offeror should propose other long and short-term positions as necessary to carry out the statement of work described in this request for task order proposals, based on the proposed approach and keeping in mind the need for collaboration rather than duplication of efforts across other complementary USAID-funded programs. The proposal should include resumes for all proposed personnel. Resumes should include information indicating whether the individual is currently an employee of, or consultant to the Offeror. The Offeror is also expected to outline a basic recruitment strategy (outlets/agencies/methods) by which the Offeror shall proceed with rapid recruitment of qualified personnel within the Ethiopian context. The following positions are suggestions on positions deemed key personnel: Project Director Senior Advisor – Partnerships and Alliances Advisor – Social Marketing/Franchising to High Risk Group
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Technical and Cost Evaluation Technical Evaluation (Total = 100 points) 1. TECHNICAL APPROACH/INTENDED RESULTS = 55 points (In descending order of importance) 1.1. Clear plans to contribute to Emergency Plan results in “Other Prevention” and Treatment (Non-ART) categories. 1.2. Proposed plans to work with private sector (health providers, other) in delivery of HIV/AIDS and Tuberculosis services in Ethiopia. 1.3. Relationship of the proposed activities and implementers with partners, private sector and donors. Demonstrated linkage with, and support of, on-going private sector initiatives. 1.4. Innovative approaches that incorporate specific strategies to address gender, community, stigma and PLWHA in private sector approaches to private sector HIV/AIDS prevention, care, and treatment. 1.5. Proposed plans for leveraging public-private alliances/ partnerships/GDAs resources for increasing coverage and reach of HIV/AIDS and TB services. 2. PERSONNEL = 25 points (In descending order of importance) 2.1. Qualifications and relevant experience of proposed technical personnel, including experience in developing country settings. 2.2. Appropriateness of the proposed technical positions (long and short term) to the proposed technical approach. 3. PAST PERFORMANCE/PAST EXPERIENCE = 20 points (Of equal importance) 3.1. Demonstrated experience working with the private sector – both health care providers, and non-health commercial sector 3.2. Demonstrated experience in social marketing/promotion of both products and services related to HIV and AIDS 3.3. Substantive inclusion of Minority Small Businesses 4. COST EVALUATION (The Cost Proposal evaluation has no value, unless all other technical evaluation factors become equal.) 4.1. Cost Realism: This evaluates the Offeror’s ability to perform within the estimated cost. Past performance references may be checked to determine the Offeror’s cost effectiveness on those activities. Budget proposals that provide best value, including ceilings on indirect cost rates, and have demonstrated effective cost controls in other activities will receive favorable review. Proposed costs may be adjusted, for the purposes of evaluation, based on the results of the cost analysis and its assessments of reasonableness, completeness, and credibility. 4.2. Validity of Costs as Proposed by the Offeror: This evaluates the Offeror’s proposed costs in relation to the proposed technical effort and with respect to the Offeror’s understanding of the solicitation’s requirements and its management approach. 4.3. Completed Biographical Data sheets, form AID 1420-17 for proposed personnel, including salary history for the previous three years. Bio-data forms must be signed by both the employee and the Offeror. 4.4. A detailed budget including both level of effort and other direct costs. Please provide a separate budget line item for each proposed individual and identify each by name and position category. For other direct costs, please include a narrative explanation of the basis of estimate for each item.
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